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Full text of "Documents Urban Moving Israeli 9/11 Involvement"

Fip02 (Rev. 10-6-95) 



-1- 



FEDERAL BUREAU OF INVESTIGATION •£$ 






DATE: 07-30-2010 

CLASSIFIED BY UC60322LP/PLJ/CC 

REASON: 1.4 (c) 

DECLASSIFY OH: 07-30-2035 



ALL INFORMATION C OBTAINED 

HEPEII IS MCLASSIFIED EXCEPT 
liHERE SHOW OTHERWISE 



Date of transcription 09/15/2001 



address \ 



DOB: 



[ 



, SSN: I Ihom e 

J NJ, home telephone I I 

was interviewed at his business DEBELLIS INSURANCE 
INC. (DIA) , 492 Franklin Avenue, Nutley, N J 07 110. Also 
pres ent during the interview were I ~ no ? - I „ J 



AGENCY, 



ggN;f 



land 



I 



DOB: 



SSN:|_ 



1' 



n 



NJ i 

J - After the 



identity of the interviewing agen t and the nature of the interview 



was made known, 
information: £,m ^ 



volunteered the following 



company was started by 



is the 



of DIA. The 



is the 



in 1961. C u ) 

I^F 



helps him out at DIA on occasion. ( 

and does not work for DIA.£t*} 



and 



is a friend of 



In June of 2001, a telemarketer from DIA contacted URBAN 
MOVING COMPANY (UMC) to s olicit busines s. The telemarketer made an 
appointme nt for | j to meet with a 



LNU on ng/nfi/2 



>00 



1. 
LNU 



was unable to meet in person so he spoke with 

the telep hone and w rote UMC a Commercial Auto Policy for tneir 

nnnHn r.fpH all f.h fi business with UMC via 

I never went to the offices of 



on 



vehicles 

t e 1 ephone ana tacsimi 1 e 



UMC. 



UMC 



is a household furnishings moving company. £u) 






( | recently received a check from UMC as payment 

for their insurance. The check was drawn on account 1036500845365, 
from CHASE MAN HATTAN BAN K. The check number was 8466 in the amount 
of $3,463.37. I I provided a copy of the check and a copy of 
all the documents in their files relating to UMC.^^ 



remembered one male from UMC com ing to DIA to 

did 



pick up some driver ' s licenses of drivers for UMC. 

not know the name of the individual, nor could he remember a 
physical description. fu\ 



he 

hlC 



hi A 



b6 
b7C 




Investigation on 09/14/2001 at Nutley, NJ 



Filefl 

by £3A 



jm 



frt 



Date dictated 



S^> 



b:i 



This document contains neither recommendations nor conclusions of the FBI. It is the property of the FBI and is loaned to your agency; 
it and its contents are not to be distributed outside your agency. 



FD-302a (Rev. 10-6-95) 



b7A 




Continuation of FD-302 of 



The writer showed 



five males : 



a photo array of the following 



Photograph nu mber 1 
DOB: 



Photograph numb er 2 
DOB: 



Photograph me mber 3 
DOB:" 



Photograph qumhfir £ 
DOB: 



Photograph numb er 5 
DOB 



their names 



di d not reco gnize anyone from the photographs or 
(Note : | | paused for quite some time while 
looking at photograph number 3.)£u) 



After looking at the photographs, 



interviewing agent if ev eryone at UMC was Israeli 



interview ing agent asked 



_ asked the 
The 



why he would ask such a question. 



[ | responded that he. also carries the insurance policy for 

MOISHES MOVING COMPANY located near the entrance of the Hoboken 
Tunnel. DIA has had the insurance for MOISHES for approximately 
one year.£cO 



subcontractors 
time. 



explained that the movers at MOISHES are all 



There are approximately 6 to 12 at any given 

stated DIA carries separate insurance policies on 

each subcontractor's business. The subcontractors are all y oung 
individuals from Israel just out of the military. | stated 

he knows this benan.gfi i -.hp subcontractors talk openly aooun their 
experiences. | | also stated the subcontractors seemed to be 
all hard working nice individuals. Cu) 



t | has met all the subcontractors and employees of 

MOISHES and knows them by sight. The subcontractors regularly come 
into DIA's office to make payments and drop off any necessary 
insurance documents. r^J 




w )Cn Si 



FD-302a (Rev. 10-6-95) 



b7A 



r 



m 



he 

hlC 



Continuation of FD-302 of 



' l ^^K®ftT n 09/14/2001 _ 3 

>^^U'fljj\r( t , On ' ' , Page 



All documents provided by DIA will be maintained in a 1A 
with the case file. This report relates to NK1765.£t4\ 








->, 



. ,: . *,?.***&}*.'$<&&&•*•* -. . . 






URBAN MOVING SYSTEIWSi INC. 






V- fe ^'v* THE CHASE MANHATTAN BANK, N.% ,y 
*." " /#'£'& 770 Lexington Avenue # iJi 

/r ' : '' "" ■■""* : s «New York, NY 10021, ' : ' '■ 









'if 






'$#£# 
''.&>• 



8466 






Vv 



»# 



":;:■■' ^ 






Sf DeBellis Insurant 



**3,463.37 



Three Thousand Four Hundred Sixty-Thr,eeanpj37/100' 



i***************************************************** 



DeBellis Insurance 



>f T 'f 



;■ •, ft-'.: '.:', 



■5 



MEMO 



, ft 

i- 4 



*?■<& 






aYv^ 



$ :? 



insurance installment ffc;;V 



DOLLARS 



V!" 












■oaauEEtii- i:o a idoo l aaizioa&BQQaiiSaEiSii 1 



■ :» ;■ .' 

S 

f ;■;;, 




ft 2: 
*-& ^ : ."' 

W 3? 



fr?- 



'1 

f 


















v; ;',.^;§f 






''>;;„■,';'''!;,.' 



I 






':, ' f ," ' / 






, ' \'< 


•;>. 




'.1 


$ ' 





DEBELLIS INS AGENCY, INC 

492 FRANKLIN AVE. 

NUTLEY, NJ 07110 

973-661-1500 
FAX 973-661-9750 



FACSIMILE TRANSMITTAL SHEET 


TO 






FROM: 


















.b6 
b7C 


COMPANY: 

Urban Moving . 

FAX NUMBER: 


DATE: 

09/07/01 
TOTAL NO. OF PAGES INCLUDING COVER: 

02 




PHONE NUMBER: 


SENDER'S REFERENCE NUMBER: 




RE: 

WORKER'S COMP - RENEWAL 


YOUR REFERENCE NUMBER: 




NO 


TES/COMME1 


SITS: 











Please sign and return the enclosed form to my office naming me as your agent on the 
worker's compensation renewal. There will be no difference in premium. I will service 
this policy in conjunction with your commercial auto. 

If there are any questions please contact me. 



Sincerely, 






Received: 1/11/01 4:25PM; ^^ 

01/11/01 16:08 f?2ojQp2 9434 



201 662 94-34 -> HP LaserjA3ioo; Page 2 

' INSURANCE OFFICE W" DEBELLIS 



aoo2 



AGENCY 

LgWTWEfllP!. 



ACQBD n AGENT/BROKER OF RECORD CHANGE 



PRODUCER 



cooe 






INSURANCE COMPANY NAME 

CNAjCkis Co. 



DATE 



POUCY NUMBEHp) 



(oS5 g HuVA>TMX6,fiK 'wy> 



EFFECTIVE OATH 



Cfl-lg-OO 



EXPIRATION DATE 



OM8-QI 



UN5 OF BUSINESS 



_WfifWs_C£ii 



r 



Please be advised that we wish to name {WM^y "freftelRs floppy -mc 

/ PRODUCER V / 



CODE* 



as our exclusive representative effective QQ-ra-iM 



DATE 



for the lines of business shown above, currently in force or submitted 
by application. 

This authorization replaces any other authorization that may have been 
previously completed for any other insurance representative for the 
stated lines of business. 

JSfPlease rescind the day waiting period 

□ There will be no rescission letter 



JSL 



£l 



INSURED'SjSIGNATURE 



DATE 



TITLE (IF APPLICABLE) 



(SsMPANy/iAME (IF APPLICABLE) 



(IF APPLICABLE) 



ACORD 36 (1/98) 



/a A/^riDn i^rtQQno *Tir»u ^aa<» 



DIA 

DeBELLIS INSURANCE AGENCY, INC. 



492 FKANKLIN AVENUE, NUTLEY, NEW JERSEY 07110 • Tel: (973) 661-1500 • Fax (973) 661-9750 



July 09,2001 



Urban Moving 
3 18 th St 
Weehawken, NJ 



Attn: 

Re: Insurance Proposal 



he 

b7C 



Dear 



We spoke several weeks ago and I advised you that my firm would like an opportunity 
to quote the insurance coverage for your moving company. I advised you at that time 
that my office presently works with other moving firms both small and large. 

The information I will need to obtain is as follows: 

1. Copies of Policies (Auto, Cargo, Warehouseman Liability, Commercial 
Package, Worker's Compensation, Commercial Umbrella) 

2. Schedule of Vehicles (to include - year, make, model, VIN number, cost new, 
GWV) 

3. Schedule of drivers (name & license number) 

4. Three years of loss runs from your current/prior carriers 

If there are any questions please feel free to contact me. 
Sincerely, 




. — ■ ..— "-i ;..- «wu;otim* i.golt(^ Designation (ChecKunej ix vj" - Renewal U Inforca 

tffittSK^ § ^ ?ooK G ■ioowy Statement 



:>u have the right to receive at this time 
an itemization of the Amount Financed. 



(Til w»rrt an nvnnttlong) I do wrt went an rtsmtartion 



Total Premiums.. 



Cash Down Payment Required 



$ 38§2Q,| oo 



9730 rOO 



l5Sn agreement no. and/or quote no. 



: ie.oo 



Amount Financed (The Amount of 
credit provided to me or on my behalf) 




FINANCE CHARGE 

(Dollar emdunl credit will cost me) 



INSURED/BORROWER <7l , ^ ^ - 

(Name, Addresa and Telephone NUituser) I 

URBAN MOVING SYSTEMS INC - L _ 
3 18TH STREET 

WEEHAWKEN, NJ 07087 



Total of Payments (Amount I will have 
paid after making all scheduled payments) 



19S0 |33 



$ 31170 133 



Pm Phone No: 



AM Phone No; 



AGENTo'r^ROKER (Name and Business Address) ; 

DEBELUS AGENCY 
492" FRANKLIN AVE 

NUTLEY.NJ 07110 

Phone No; FaxNo: 



PPP CODE 




PPP .PREMIUM PAYMEHT PLAN 

Hudson City Centra - ^tntr of Green & Sfet» 3t 

Hut*MnJ^12«4 

6tMt M00Q * P ** fi1MZi*87X> ■_ 



ANNUAL PERCENTAGE RATE 

(Cost of my credit figured as a ye arly ra ta) 



16.00 



% 



Amount of 
3463:37 



Pavm ent Sched tij_e 

Number of Payments Payable ; 

"nSonffi!; 



"lAnnuaVT Quarte rly 



9 



1at 
09/05/01 



Final 

Payment D 

05/05/02 



_L2ir*-=ii-v :■ . ,., TTL ««»•«««* a lata eharoe will be impoaed on any installment which I 

Pw^e^'^yprewmetollamountdueun^^^^^ 

Kt •noTHXJSe service charge of«l6lnCT. NY, PA $12 m NJ.nrf made wHn we W «^ p^™,*. The late charae «V «**• 

todudedtalne^e^lnl^^ cham. by etete. 



nctuded in flnence cns^s in i«. "v •-""•"'" ."*, j" uv ii i Mm and three 
the iffhount refundable Is less than one dollar ($1 in NY, NJ. MD) ana three 
•faiinnt (S3 in CT PA RIV or maximum allowed by state. 
afi&MMWtAi r security tor the payment* to be made. I am •wgnmg 

?e"uWSd^ 

Zidn reduce the unearned premiums. This mean, that thla money can be 

used to pay amount* due under this agreement.^ 



charge by state. 

Contract Reference Reference should be made to the ten™ of this 
Agreement ae stated below and on the next page tor infbmjeHon about 
KSnt, default, the ri 8 hl to accelerate, the maturity of ttw obligation, 
and prepayment, rebatoa. and penalties 






Type of 
Insurance 



BA 



Policy Number 
and Prefix 

BINDER 



Full Name of Insurance Company and Now (N) 
Name and *ddr*as of Genera Agent or * renewal W 
Com pany Offi ce to Which P remium * Paid | Policy * -> 



EMPIRE INS/ 



Effective Date; 
Mo. Oay Yr.: 




^^^s^^^^^tis^r^t^tssssss^ 



Taxes 



Premiums 
(Record to "A*) 



Policy 
Premiums 



38920 



38920 



00 



00 



00 



00 



in mis Agreement, .....— —.---. (R»cordHi^r; :i 

charge as stated above. , 

2. Taxes *F*«. I Understand the following 



.'understand the following'. o^^„.. ^Pniiffeft listed above this fee la charged under Section 21 19 oflheNaw York Insure 



(CONTINUED ON REVERSE SIDE) . . f are , ncorpara ted by referenc e and constitute o part* ^0!*™™!: 

and un der certafn condition s to obtain a partial refundof th e finance cnarga. 
VT^Tf^^py rf thjajto jawm it to protect your legal ri ghja. . _ 



NOTICE 

TO 
INSURED 



LDoUSelgn this Agreement before' you read It or if it contain* 
any wank space. 



TYOuareiniiMto a afmpletaly filled In capypfml* Aoj^ment, 



stpa^&^^^- s ^ — ■ — ' — 



&- 



-^ 



, (5tonatu«o(lniw«a) 



: FOR IMPORTANT INFORMATION 



' ^ ^BTonsluraaAdThbrfJIamltiraiuO '"" 

D* -t— b6 " 

b7C 



.EOSWOB 



o 1~p afioj 



( iAt_j:? 1 • c 



• finv 



!ju :Aa mac 



DEBELLIS INSURANCE AGENCY, INC 
.492 FRANKLIN AVE. 
NUTLEY, NJ 07110 

973-661-1500 
FAX 973-66 1-9750 



FACSIMILE TRANSMITTAL SHEET 


TO: 


FROM: 




b6 
b7C 


I I 








COMPANY: 

Urban Moving Systems 


DATE: 

08/01/01 




FAX NUMBER: 


TOTAL NO. OF PAGES INCLUDING COVER: 

03 




PHONE NUMBER: 


SENDER'S REFERENCE NUMBER: 




RE: 

COMMERCIAL AUTO 
OUOTATION - REVISED 


YOUR REFERENCE NUMBER: 




NOTES/COMMENTS: 











Per our conversation today please be advised I have obtained the following quotation on 
your commercial autos: 

Liability Limit $1,000,000 

Comprehensive & Collision Deductible $1,000. 

Total Annual Premium = $38,920 - 

Deposit Required to Bind = $9,730 (the balance of the premium can be financed on 9 

monthly installments). Please make check payable to DEBELLIS AGENCY. 

This indication is based on 6 units with total values of $237,995. 

If there are any questions please contact my office. 



Sincerely 




^iVltnc*. ^9 



[re£ ^J +> J*± Tky^^ Coupon are eoc 



Mt^ 



\&sed ( 



OiO 



I -s-srSr-^^^ ^* 



PPP - PREMIUM PAYMENT PLAN 



. You have the right to receive at this time 
' an itemization of the Amount Financed. 

™ l want an itemization 3C I do not want an itemization 



IPRPMIUM FINANCE AGREEMENTS ) DISCLOSURE STATEMENT 

1 Policy Designation (Check One) S Commercial □ Personal □ Assigned Risk 

2. Type of Agreement (Check One) H New Q APC □ Renewal Q Inforce 

3 Preferred Billing Method (Check One) ■£ Coupon Book □ Monthly Statement 



LOAN AGREEMENT NO. AND/OR QUOTE NO. 



Total Premiums 



Cash Down Payment Required 



$ 38920 1 00 



$ 9730 1 00 



C Amount Financed (The Amount of 
credit provided to me or on my behalf) 



FINANCE CHARGE 

(Dollar amount credit will cost me) 



$ 29190 ,00 



$ 1980 ,33 



Total of Payments (Amount I will have . 
paid after making all scheduled payments) 



$ 31170 133 



16.00 



INSURED/BORROWER 

(Name, Address and Telephone Number) 

URBAN MOVING SYSTEMS INC 

3 18TH STREET 

WEEHAWKEN, NJ 07087 



ACCT. NO. 



Pm Phone No: 



AM Phone No: 



AGENT or BROKER (Name and Business Address) PPP C0 DE 

DEBELLIS AGENCY ^11 1OTOBMATIOW CO^^^ 
492 FRANKLIN AVE *£££ ««m.A AftTFIED «* 



NUTLEY.NJ 07110 
Phone No: 




Fax No: 



•^ 




PPP - PREMIUM PAYMENT PLAN 
Hudson City Centre - Corner of Green & State St 
_ Hudson, NY 12534 

R 518-822-1000 * Fax 518-828-5729 



ANNUAL PERCENTAGE RATE 

(Cost of my credit figured as a yearly rate) 



16.00 



% 



Amount of 
Each Payment 



3463.37 



Payment Schedule 



Number of Payments Payable 



Annual 



Quarterly 



Monthly 



9 



1st 
Payment Dilie 



09/05/01 



Final 
Payment Dt 



05/05/02 



Prepayment I may prepay the full amount due under this Agreement. If I Late Payment A late charge will be imposed on any Jn* n ™ rt a «J>J* l! 
* £jta£ is a non-ref5ndable service chargeof $10 in CT, NY, PA; $12 in NJ; not made within five (5) days of the "^^O^^ 1 *™- and MS) 
$15 in Rl and KY* $20 in MD* 4% - $15 maximum in TN; $30 non-refundable fee This late charge will be 5% of the payment. The late charge will be a 
included inTnanS uneamed'interest will be made if minimum of one dollar ($1.00) ($2 in TN). See back of form for maximum late 
^'-^»'»«w — i*u™ charge by state. 



the amount refundable is less than one dollar ($1 in NY, N J, MD) and three 
dollars ($3 in CT, PA, Rl), or maximum allowedly state. 
Security Interest As a security for the payments to be made, I am assigning 
to you all unearned premiums under the Policies, and all loss payments 
which reduce the unearned premiums. This means that this money can be 
used to pay amounts due under this agreement. 



Contract Reference Reference should be made to the terms of this 
Agreement as stated below and on the next page for information about 
nonpayment, default, the right to accelerate, the maturity of this obligation, 
and prepayment, rebates, and penalties | 



SCHEDULE OF POLICIES: Personal Auto - Bl (Bodily Inj ury) - PP (Property Damage) - HO (Homeowners) - F (Fire) - ML (Multiline) - MC (Motorcycle) ■ BOP (Business Owners) 

* — — — I ' " .... _ . —. ~~t ti /ki\ /M\ T«rm . _. .. 



Type of 
Insurance 



BA 



Policy Number 
and Prefix 



BINDER 



Full Name of Insurance Company and 

Name and address of General Agent or 

Company Office to Which Premium is Paid 

EMPIRE INS/ 



New(N) 

or Renewal (R) 

Policy — > 



N 



Term 
In Mos. 
Cov. by 
Prem. 



12 



Effective Date 
Mo. Day Yr, 



08 06 01 



Taxes 



Policy 
Premiums 



38920 



38920 



00 



00 



00 



00 



Wherever the word "Policy" is used, it means those things listed above in the Schedule of Policies. Whenever "you" is usetiFees____ 

SXeemenU^ 

it means the insured undersigned. .1^,,,^™^/^ (Record in "A") 

charge as stated above. 

2 ^^^^as^sssasssssssssr 



SSSS3SSSSS. M >e p^. T » <* -mm. e^- »--« »y ■«— - -j*T ~?~*?r~: 

1 . Do not sign this Agreement before you read it or if it eQitains 



NOTICE 

TO 
INSURED 



any blank space, 



2. You are entitled to a completely filled in copy of this Agreement. 



3 Under the law, you have a right to pay off in advance the full amount due 
and under certain conditions to obtain a partial refund of the finance charge. 



4. Keep your copy of this Agreement to protect your legal rights. 



All insureds 1st sign as named In policies. If corpor ation, authorized officers m US t sign; If partnership, partner should sign as such; signatory actmg In representatures 
capaci tyrepresentsthataiilnsuredshaveauthorizedthlstransactio, ___ „ iutat ^^ fam ^ ^= ^- 

: L """ ""(Signature and Title of Agent or Broker) 



By. 



tfo 



be 
-b7C 



Date 






(Signature of Insured) 



Date 



MntifSF NFXT PAGE FOR IMPORTANT INFORMATION 



ECS 5/95 



From: URBAN MOVING SYSTEM: 

3 18TH STREET 
WEEHAWKEN, NJ 07087 



^C 



Place stamp here 



Attn: Process Immediately 

PREMIUM PAYMENT PLAN 

HUDSON CITY CENTRE 

CORNER OF STATE & GREEN STREETS 

P.O. BOX 668 

HUDSON, NEW YORK 12534-0668 



(Fold with the above facing out for mailing) 



Premium Payment Plan 

PO Box 668, Hudson, New York 12534-0668 

Dear Insured: 

Welcomel It can take over a week to receive your payment coupon book. This is your first payment coupon. To avoid 
late charges, your payment must be received by PPP on or before the due date. Payment to your agent or broker 
does not eliminate the late charge. MAIL EARLY!! 

The easy way to get and keep your needed insurance coverage, finance your policies with Premium Payment Plan, 
easy and flexible payment schedules with low down payments to help you afford the best protection available. 

Why should you deal with multiple bills for each insurance company? Finance all your insurance and pay only one bill 
each month. PPP is here to serve you through the best professional independent insurance agents and brokers in the 
country. 

Call us at PPP if you have any questions (518)822-1000 



(For mailing, fold-up the below section -place check in the fold - tape or staple all 4 sides) 
FIRST PAYMENT COUPON: 



Policies 



Insurance Co 



General Agent 



New/Renew Term Effective Date 



Premiums 



BINDER 

B 

B 



EMPIRE INS 



08/06/01 




n^%sm 



3892000 



Taxes 

Fees 

TOTAL 38920 00 



Make check payable to Premium Payment Plan. Include check- fold, staple, mail 

Insured's Name: URBAN MOVING SYSTEMS INC p ue: 09/05/01 

Address: 3 18TH STREET Amt Due: 3463.37 

WEEHAWKEN, NJ 07087 



Agent/Code: 



DEBELLIS AGENCY/ 



Premium Payment Plan * PO Box 668, Hudson, NY, 12534 * Tel. 518-822-1000 



B8-1Q-81 93i-Q6 

i»J6. 10.2001 



2:2/™ B' 



■\hBi 



UJKU lN&UK/mtaut Ins. 



ID = 
Eft; 03/ 01/ 



/IT98 



PQ1/Q1 



Vehicle 



2000 GMC Van : a999 International ; 



vehicle Type : Truck .- 

: Not Otherwise Clas 

Class Code i 03199 

fciab Factor : 1.30+0-00=1.30 

P&Y Dam Factor : 1-I0r0.00~l.i0 

Territory : io si 

Cost Netf * : $13 ,000 

Age Group r 2 



Truck 

Not otherwise Clas 

33199 

1.55+0.00=1.55 

0.80r0.0O*G,8O 

10 

$35,000 
3 



?!!ff! ga : Li * its : pr *^ = L^r™^^" 



Liability 
ttedical ?ay 
PIP 
DM 

Coverage Type 
Other Than Cal 
Collision 
Premium 



:$1, 000,000 $2543 

:Kone 50 

: Pedestrian 0. 

:$1. 000,000 $216. 
: Comprehensive 

: $1,000 ded 5141. 

: $1,000 ded $345. 

: $3245. 



0D;$1,00Q,000 $3019.00 

00-N D ne $0.00 

62: Pedestrian 0.62 

00:51,000,000 $216,00 

r Comprehensive 

00;$1,000 ded $138.00 

00:S1,000 ded $401.00 

52 : $3774.62 



<3 



focal Annual Premium ; $7,020.00 



■hx daa.q 



QS-10-Q1 92:27 TO: 



FROM: 



PQ3 



/vt.T. JNPORMA-TIOJr COITOOHEB^ 

HEREiiiis ^classified ^V .• . 



-"■•" "•"\ rrr "■■" 



RUG 10 2001 12:32PM HP^RSERJET 3200 



p.l 



New Jersey Headquarters 
■3, 18* Street 
-Weehawken, NJ 07087 
(201}55&-0031 



Urban Moving Systems, Inc. 



New York Headquarters 
446 West 50 m Street. 
New York, NY 1QT019 
(212) 338-9267 



Debellls Insuram 



[£S 



VIA FACSIMILE: 973-661-9750 



bb 
hlC 



Dear 



The intonnaion you requested Isbelow. Please call me to confirm that you received them and that the application is on it's 
way. 




Urban Moving Systems, Inc, 



MC 320465 
NYSDott-33739 
US Dot 691256 
PC 0076006 



MC 398463 
USDOT 923345 



1 



8-lo -ci 



? 



lease -fi\x "<■ da p' 



&~s o-f all v/etac/e 



rea»s4nJtens a* Soon as pofis/ife. ^^/ 6U " 



(t 



AT.T. IKPOHMA.TIOW CO! 
>^T BY. 




3«a&fc 



m 



^ 

6 



RW. 



mm 



BC?. 
01 



LUCID LAljjii 



i 



iiAi/' 



* V 



492 Franklin Avenue 
Nuiley, New Jersey 07110 
Phone: (973)661-1500 
Fax: (973)661-9750 



Fax 



b6 
b7C 



To: | 


From: 






Co.: ^To : 4"dr Pages: |Q 


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■* . * 



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ALL INFOEMATION <WmMB»\ 



ACORD COMMERCIALnNSURANCE APPLICATION 

HlsUKU n XPPLICANT INFORMATION SECTION 



PRODUCER I PHONE 



(AIC Mo FyI) 



,(973)661-1500 



FAX 073)661-9750 

DeBellis Insurance Agency, Inc. 
492 Franklin Avenue 
Nutley, N3 07110 



SUB CODE: 



AGENCY CUSTOMER ID 

00007675 



CARRIER 



NAIC CODE: 



Inter-America Ins Agency 



0ATE 

08/03/2001 



UNDERWRITER 



POLICIES OR PROGRAM REQUESTED 

CA 



INDICATE SECTIONS ATTACHED 



PROPERTY 

GLASS AND SIGN 
ACCOUNTS RECEIVABLE/ 
VALUABLE PAPERS 

CRIME/MISCELLANEOUS CRIME 

TRANSPORTATION/ 

MOTOR TRUCK CARGO 



EQUIPMENT FLOATER 

INSTALLATION/BUILDERS RtSK 

ELECTRONIC DATAPROC 
COMMERCIAL 
GENERAL LIABILITY 

BUSINESS AUTO "*' 

TRUCKERS/MOTOR CARRIER 



GARAGE AND DEALERS 
VEHICLE SCHEDULE 
BOILER & MACHINERY 
WORKERS COMPENSATION 
UMBRELLA 



STATUS OF SUBMISSION 






PACKAGE POLICY INFORMATION 










X 
X 


QUOTE 


X 


ISSUE POUCY 


ENTER THIS INFORMATION WHEN COMMON DATES AND TERMS APPLY TO SEVERAL UNES. OR FOR MONOUNE POLICIES. 


BOUND (Give Date and/or Attach Copy): 


PROPOSED EFF DATE 


PROPOSED EXP DATE 


BILLING PLAN 


PAYMENT PLAN 


AUDIT 


DATE 

08/06/20 


Dl 




TIME 

12:01 


X 


AM 
PM 


08/06/2001 


08/06/2002 


X 


DIRECT BILL 
AGENCY BILL 







APPLICANT INFORMATION 



NAME (First Named insured & Other Named Insureds) 

URBAN MOVING SYSTEMS INC 



E J& & S0C 3 EC# ^22-3511891 

if First Name d Insured): 



INDIVIDUAL 
PARTNERSHIP 



CORPORATION 
JOINT VENTURE 



SUBCHAPTER "S" CORPORATION 
LIMITED CORPORATION 



IT 



MAILING ADDRESS 1NCL Z1P+4 (of First Named Insured) 

3 18TH STREET 
WEEHAWKEN, N3 07087 



HUDSON 



INSPECTION CONTACT 



IfilSHSUw, C201) 558-0031 



ACCOUNTING RECORDS CONTACT 



E 



NOT FOR PROFIT 
ORGANIZATION 



BUSINESS STARTED 

1990 



sisaL 



£xlU- 



PREMISES INFORMATION 














LOC# 


BLD* 


STREET, CITY, COUNTY, STATE, ZIP+4 


CITY LIMITS 


INTEREST 


YR BUILT 


PART OCCUPIED 


00001 


00001 


3 18TH STREET 

HUDSON 
WEEHAWKEN NJ 07087 


X 


INSIDE 
OUTSIDE 


X 


OWNER 
TENANT 




be 

hie. 






C 




INSIDE 
OUTSIDE 




OWNER 
TENANT 










■8 




INSIDE 
OUTSIDE 




OWNER 
TENANT 







NATURE OF BUSINESS/DESCRIPTION OF OPERATIONS BY PREM1SE(S) 



MOVING & STORAGE (HOUSEHOLD) 






GENERAL INFORMATION 



EXPLAIN ALLIES** RESPONSES 



YES 



1. IS THE APPLICANT A SUBSIDIARY OF ANOTHER ENTITY OR DOES 
THE APPLICANT HAVE ANY SUBSIDIARIES? 



Z IS A FORMAL SAFETY PROGRAM IN OPERATION? 



3. ANY EXPOSURE TO FLAMMABLES. EXPLOSIVES, CHEMICALS? 



4. ANY CATASTROPHE EXPOSURE? 



5. ANY OTHER INSURANCE WITH THIS COMPANY OR BEING SUBMITTED? 



6. ANY POUCY-OR COVERAGE DECUNED, CANCELLED OR NON-RENEWED 

nilRIMB THE PRIOR 3 YEARS? NOT APfr ICABI.E IN MQ 

REMARKS 



NO 



EXPLAIN ALL"YES H RESPONSES 



YES 



^■^s^Rmp^m s ^^m^m^HM^ m ^ 



8. DURING THE LAST TEN YEARS, HAS ANY APPLICANT BEEN CONVICTED 
OF ANY DEGREE OF THE CRIME OF ARSON? (In Rl, this question must be 
answered by any applicant for property Insurance. Failure to disclose 
the existence of an arson conviction Is a misdemeanor punishable by a 
sentence of up to one year of Imprisonment). 



9. ANY UNCORRECTED FIRE CODE VIOLATIONS? 



<i 



ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSUR^ECOUPANY 'OR ANOTHER 
DPR<lnN ph pe^ CM APPLICATION FOR INSURANCE OR STATEMENT OF CLA M CONTAINING ANY MATERIALLY 
pIifprnFORWIATION OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING 
ANY FACT MATERIAL THERETO, COMMITC^ IS A CRIME AND 
SUBJECTS THE PERSON TC TcR M1NAL AND TNY: SUBSTANTIAL! CIVIL PENALTIES. : 



APPLICANTS 

SIGNATURE 



PRODUCER'S 
SIGNATURE 



AD 



ACORD 125 (8/97) 



PIEASE COMPLETE REVERSE SIDE 



©ACORD CORPORATION 1993 



PRIOR CARRIER INFORMATION 



LINE 


CATEGORY 


1993-2001 


G 

E 
N 

C R 

Sa 

CA 

T 
Y 


CARRIER 












POLICY NUMBER 












POLICY TYPE 


I CUlMS 
I WCE 




CCCfl^SlCE 




CLAIMS 




CCCyRRGf.CE 


1 CUIUS 
1 M-CE 


j CCC'J^ENCE 




C'JHMS > 
Mi3E - 


OCC'-HRS-'iCE 


1 ^ 


c;s„»?.a 


RETRO DATE 


i 








EFF-EXP DATE 












GENERAL AGGREGATE 












PRODUCTS CC-MP OP 
AGGREGATE 












PERSONAL &ADVINJ 












EACH OCCURRENCE 








*•* 




\ FIRE DAMAGE 












" MEDICAL EXPENSE 












S B 

to 


ODILY OCCURRENCE 












,JURY AGGREGATE 












PR( 
D/ 


3PERTY OCCURRENCE 












WIAGE AGGREGATE 












COMBINED SINGLE UMIT 












MODIFICATION FACTOR 












TOTAL PREMIUM 














t 


CARRIER 


VAN LINER INS CO 










POUCY NUMBER 












POLICY TYPE 












EFF-EXP DATE 












COMBINED SINGLE UMIT 


1,000,000 










BG 

IN. 


D ILY EA PERSON 












URY EAACCIDENT 












PROPERTY DAMAGE 












MODIFICATION FACTOR 










• 


TOTAL PREMIUM . 












p 

R 

P 

E 
R 
T 
Y 


CARRIER 












POUCY NUMBER 












POUCYTYPE 












EFF-EXP DATE 






A 








BUILDING AMT 














PERS PROP AMT 












MODIFICATION FACTOR 












TOTAL PREMIUM 














CARRIER 












POUCY NUMBER 












POUCYTYPE 












EFF-EXP DATE 












UMIT 












MODIFICATION FACTOR 












TOTAL PREMIUM 













LOSS HISTORY 



ENTER ALL CLAIMS (REGARDLESS OF FAULT) OR OCCURRENCES THAT MAY GIVE RISE TO CLAIMS FOR THE PRIOR 5 YEARS (3 YEARS IN KS & NY) | F NONE * LOSS SUMMARY 


DATE OF 

OCCURRENCE 


UNE 


TYPE/DESCRIPTION OF OCCURRENCE OR CLAIM 


DATE 
OF CLAIM 


AMOUNT 
PAID 


AMOUNT 
RESERVED 


CLAIM 
STATUS 
















OPEN 




CLOSED 
















OPEN 




CLOSED 


REMARKS NOTE: FIDELITY REQUIRES A FIVE YEAR LOSS HISTORY 


NOTICE OF INSURANCE INFORMATION PRACTICES ^ „ „ mnMt . , 

PERSONAL INFORMATION ABOUT YOU MAY BE COLLECTED FROM PERSONS OTHER THAN YOU. SUCH INFORMATION AS WELL AS OTHER PERSONAL 
AND PRIVILEGED INFORMATION COLLECTED BY US OR OUR AGENTS MAY IN CERTAIN CIRCUMSTANCES BE DISCLOSED TO THIRD PARTIES WITHOUT 
YOUR AUTHORIZATION. YOU HAVE THE RIGHT TO REVIEW YOUR PERSONAL INFORMATION IN OUR FILES AND CAN REQUEST & CORRKTON OF ANY 
INACCURACIES. A MORE DETAILED DESCRIPTION OF YOUR RIGHTS AND OUR PRACTICES REGARDING SUCH INFORMATION IS AVAILABLE UPON REQUEST. 
CONTACT YOUR AGENT OR BROKER FOR INSTRUCTION ON HOWTO SUBMITA REQUESTTO US. 



ACORD 126 (8/97) 



PRODUCER 



PHONE" 
(A/C, No, Ext): 

FAX 



(973)661-1500 
(973)661-9750 

DeSellis Insurance Agency, Inc. 

492 Franklin Avenue 

Nutley, NJ 07110 



CODE: 



: SUB CODE: 



ffJJTOMERlD: 00007675" 



applicant URBAN MOVING' 'SYSTEMS INC' 

(First 

Named 

Insured) 



EFFECTIVE DATE . EXPIRATION DATE 



0IRECT3ILL 



PAYMENT PLAN 



08/06/2001 1 08/06/2002 X agency bill . 



FOR 

COMPANY 
USE ONLY 



Q 



*,. 



COVERAGES : COVERED AUTO SYMBOLS 1 



LIABILITY 



PERSONAL INJURY 
PROTECTION 



ADDITIONAL 
P.I.P. 



MEDICAL 
PAYMENTS 



UNINSURED 
MOTORIST 



UNDERINSURED 
MOTORIST 



S1 ! 

= 3 i'XIa 



UMTTS 

t'bi :■■■■ 

■ EAPER s 



: -5 

[xIt 

: i5 
: ■: 

j 17 

: = 2 

I J3 

\ \2 

{ :3 

\ ;4 

i j2 

: :3 

; U 



; X j 9 : X j csl j 

:BI EACH ACCIDENT 
\ PROPERTY DAMAGE 

I OR EQUIVALENT 

j NO-FAULT COVERAGE 



1,000,000 



DEDUCTIBLE 



: i 4 
j J7 
i 16 
[XJ7 

i Is 
j'xl 7 



[TOTAL 
|$ 

! EACH PERSON 



W/C S 
M/E $ 



u , ™,» rt „„^™ : STATES 
HIRED/BORROWED : M] 

LIABILITY I 



[XjCSL \ j EAPER $ 

JBI EACH ACCIDENT $ 

j PROPERTY DAMAGE $ 

: X j CSL \ \ EA PER * 

j Bl EACH ACCIDENT $ 

j PROPERTY DAMAGE $ 
I COST OF HIRE 



m~T 1^000^000 



1,000,000 



: . X ! IF ANY BASIS 



: STATES 

;NJ 



NON-OWNED 
LIABILITY 



i GROUP TYPE 
: EMPLOYEES 

I ! VOLUNTEERS 
j PARTNERS 



NUMBER OF 



COVERAGES [ COVERED AUTO SYMBOLS j LIMITS 



TOWING 
& LABOR 



COMPREHENSIVE 



SPECIFIED 
CAUSES OF LOSS 



COLLISION 



PHYSICAL DAMAGE 
! 3 
[7 

= 2 J :4 I 18 

■ 2 : j 4 I : 8 

• 2 j !4 j ! 8 

Is \X\7 



:$ 






HIRED 

PHYSICAL 

DAMAGE 



STATES i #DAYS j #VEH j COVERAGE/DEDUCTIBLE 

: j I COMP $ 

! j : j SPEC « 

j ■ jCOFL S 

• j : \ COLL $ 



COVERAGE IS: 



: PRIMARY 



: SECONDARY 



ENDORSEMENTS, FORMS, CONDITIONS 



COVERED <1) ANY AUTO 

AUTO (2) ALL OWNED AUTOS 

SYMBOLS (3) OWNED PRIVATE PASSENGER AUTOS 



(4) OWNED AUTOS OTHER THAN PRIVATE PASSENGER 

(5) ALL OWNED AUTOS WHICH REQUIRE NO-FAULT COVERAGE 

(6) OWNED AUTOS SUBJECT TO COMPULSORY U.M.LAW 



(7) AUTOS SPECIFIED ON SCHEDULE 

(8) HIRED AUTOS 

(9) NON-OWNED AUTOS 



UST ALL DRIVERS, INCLUDING FAMILY MEMBERS THAT WILL DRIVE COMPANY VEHICLES, AND EMPLOYEES WHO DRIVE OWN VEHICLES ON COMPANY BUSINESS. 



DRIVER* 

# i NAME (tncluda address, If required) 

„. ? 

0001! 



«AT C n CB10 Yu : YEAR : DRIVERS UC EN SE NUMBER/ :STATE: USE . % 

DATE OF BIRTH : UC SOCIAL SECURITY NUMBER : UC : VEH# : USE 




VEH# j YEAR j make. GMC 
0M01j2000|'— yfij 



CITY, STATE, ZIP 

WHERE GARAGED 

DRiVETOWORioSCHd """ T'X JcoMRITL ^ I^R^GESL 

' UNDER 15 MILES j j PLEASURE : j RETAIL j X j UAB I 

. 15 MILES OR OVER j j FARM I. \ SERVICE I X j PIP 



[y.LN.: .^ 
"TERR""] GVWGCW ■ CLASS"' 

15000 

:ADD'LPIP A MOTOR - 



Tsicf FACTOR JSEATCP: RADIUS 



20,935 

'farthktterm 



I MED PAY 

i" y"| unins 
: A {Moron. 



TOWING 
& LABOR 
SPEC 
COFL 



; F 
JFT 
I FTW 



; i'{sp I" DEDUCTIBLES j ! ACV I X 

! X ! COMP j j AA j X j STAMT j S 

X^coll j$ 20,935 Is 



comp: 



'Ts'pec* 

;COFL 



...lj.000 

1,000 COLL 



15 MILES OR OVER * : FARM : : SfctwiwE : /\ : rtr : /v ; MOTOR COFL : .!••».". ««>-_ ; * _w ,.•-_. . •* .*., www w V -*. 



^Hl@: 



00002 1999 



..make INTERNATIONAL ! typ£ 



SYM/AGE 



MODELrTRUCK 



CITY, STATE, ZIP 
WHERE GARAGED 



. . . . . J Y*!:";:. AHJSGW15X675087 

' TERR " : "" GVW/GCW " " CLASS 

I 23000 



■ s 



FACTOR SEAT CP RADIUS 



COST NEW 

42,259 

FARTHEST TERM 



DRIVE TO WORK/SCHOOL USE 

UNDER 15 MILES | , PLEASURE 
1 SMILES OR OVER ! | FARM 



CHECK 
COVERAGES 



; ADD'L PIP X 



UNDRINS 
MOTOR 

I M=n dav TOWING : 

: MED PAY & LABOR : 

:"y": UNINS SPEC :" 

. . t A : MOTOR COFL ; 

00003 3J .^.MEJMriONAL iJSS 

**** modeuTRUCK Ivjjl: 1HSDPPN9RH559152 



X COMM'L 

• RETAIL ! X : LlAB 
I SERVICE j X I PIP 



VEH* 



. F 
JFT 

!ftw; 



LSP 
X COMP 
X COLL 



DEDUCTIBLES 



SPEC 
COFL 



ACV X COMP 
: jAA jXJSTAMT [S 1,000 

Is '42,259 j's 1^000 coll' 



i SYM/AGE j 



CITY, STATE, ZIP 

WHERE GARAGED 



TERR 



: GVW/GCW 



:S 



23000 



CLASS j SIC FACTOR iSEATCP: RADIUS" 



COST NEW 

26,000 

farthestterm" 



DRivETOWO^ :"Y"TroMiupi i'CHECK T \^ntYt'om ""V " 'XfHt3lFa'SS"r""T'" """"V""" "l^x£":'---c-"-: :■--;- <0 _ K - 

j L™J C0MWL -.COVERAGES: j A 00 L PJP ..*. MOTOR j ;F LSP : DEDUCTIBLES | j ACV j X =COMP . c OF L 

UNDER15MILES I I PLEASURE I \ RETAIL I X ! UAB ! I MED PAY IWMSS \ ! irr "? ■ rnMD \ I a* "xl"^^,- [$*"" 1000 

26 f 000 [$'" Ooo'coLL 



15 MILES OR OVER 



; PLEASURE 
JFARM 



VEH# ■ YEAR 

00004" 1993: 



j RETAIL I X j UAB 

1 SERVICE IXj PIP jx'] asg 

.KJ«bF0RD >m \^l 

modeuTRUCK" 



MED PAY 

UNINS 
MOTOR 



& LABOR 

SPEC 

COFL 



jFT 
j FTW 



X ; COMP 
X COLL 



j AA 



TYPE: 



■ SYM/AGE : 



CITY. STATE, ZIP 
WHERE GARAGED 

DRtvETo "\S6rk/sW6ol1"use" 



j X j COMM'L 1 COVERAGES! I ADD'L PIP 



ivJJ^.lFpNK72O(PVA20054 

TERR I GVW/GCW T CLASS* 

| 18000 

r-UN0RTWs"r 



;$ 



SIC . FACTOR -SEATCPJ' RADIUS 



COST NEW 

15,000 

farthestterm" 



X motor' 



: F 



: LSP I DEDUCTIBLES j 



JUNDER1SMILES I j PLEASURE j j RETAIL | X I UAB j JmEDPAY &LABOr!" 



I 15 MILES OR OVER : : FARM 



j SERVICE ! X I PIP 



fX^UJNINS 



MOTOR 

BODY 

TYPE: 



SPEC 
COFL 



I ^ L.?U C0MP [ = fiA I X I STAMT j $ 
JFTW j X \ COLL j S 15,000 [ $" 



™ # 5 :^L!^^.freightliner RSS ' ' jsymwge: 



JACV j X jCOMP; : |ofT 

T,oqq 

1,000 COLL 



COST NEW 



:_1.!«9!?M!^Q< 



I vm: 1FVABPAL91HH68277 



cmr, STATE, ZIP 
WHERE GARAGED 

bRwi'TowoRwscHbou 

j UNDER 15 MILES ! | PLEASURE 
j 15 MILES OR OVER I ] FARM 



wrAL91HH68277 v j j $ 69 , 837 

TERR j GVW/GCW j CLASS TsicT" FACTOR' 'T^TC^ 

! 25500 ! ! ! j 



"y"T™m«'""T check ; 

A : COMM'L ; COVERAGES : 
! RETAIL I X ! UAB ! 



p55wc5SiST'*"7^1'^ 



jA^Diwp'x^^Tj'p uIlsp 

> | MED PAY &LABOR PJ "" P*] COMP j ] AA jYf'sTAMT JS 

j SERVICE j X ] PIP j X j MOTOR COFL I ] FTW j'Xj COLL IT" '""69,837 '"" 



"Ts'PE'd" 

:COFL 



..1,000 
1,666 COLL 



*— '*!^ ^ jF J wjA L C0LL ■ ,-. 69 ' 837 J. $ 1,000 coll 

INTEREST • RAM If* •' kiAMC Akin Annseee ! dcccdcmocj. • : «>.*««.-..-..-«- __«...«.-» : .. 



INTEREST [RANK: 

j ADDITIONAL INSURED 
j LOSS PAYEE 
! MORTGAGEE 
j UENHOLDER 
i EMPLOYEE AS LESSOR 



; NAME AND ADDRESS • REFERENCE *: 



: CERTIFICATE REQUIRED [ INTEREST IN ITEM NUMBER 

[LOCATION: I BUILDING: 

| VEHICLE: \ BOAT: 

f OTHER 



: ITEM DESCRIPTION: 



.fXPL^^n^RESPONSES 

1. WITH THE EXCEPTION OF ENCUMBRANCES, ARE ANY VEHICLES NOT SOLELY 
OWNED BY AND REGISTERED TO THE APPLICANT? 

i^.?.9.9}^?.i!??*5!LIl1S.^r.y?.X^ E :? USE THEIR AUTOS IN THE BUSINESS? 

HlTSS^y^^ IN 0PERAT ]?. N ?. 

4. ARE ANYyEHICLES LEASED TO OTHERS? 

.f.'.^SS ^SX.YS! 10155 CUSTOMIZED, ALTERED OR HAVE SPECIAL EQUIPMENT? 

6. ARE ICC, PUC OR OTHER FiUNGS REQUIRED? 






JYES: NOj: 7. DO > OPERATIONS INVOLVE TRANSPORTING HAZARDOUS MATERIAL? 
j I w [a. AW HOLD H^ 

9. ANY VEHICLES USED BY FAMILY MEMBERS? 
£ X | " 1F so > PLEASE IDENTIFY IN REMARKS. 

I XI 1 10. DOES THE APPLICANT OBTAIN MVR VERIFICATIONS? 

j } XI 1Z ARE ANY DRIVERS NOT COVERED BY WORKERS COMPENSATION? 
I I X I 13. ANYVEHICLES OWNED BUT NOT SCHEDULED ON THIS APPLICATION? 



! x 

IK 
\ x 



IX! 






DESCRIPTION OF GARAGE/STORAGE LOCATIONS 



I x 

Tx" 
"Tx" 

"T MAXiMUM DOLLARVALui SUEUECTTO LOSS 



REMARKS 



•:wfe 
DO NOT USE IN AR, AZ, CA, CT, DE, FL, GA, IA, IL, MD, NJ, NV t OK, OR, PA, RI, SC, WV; USE SPECIFIC STATE SUPPLEMENT. MINIMUM UM LIMITS REQUIRED IN DC, ME, MN, MO, VT, VA, WA, WI. 

1££^^^ r;;jsii6SGuMAE™ 

(UM) AND UNDERINSURED MOTORISTS (UIM) COVERAGES HAVE j j SELECTING UM AND UIM LIMITS LOWER THAN MY LIABILITY LIMITS, OR 

BEEN EXPLAINED TO ME. I HAVE BEEN OFFERED THE OPTIONS OF: 



I REJECTING COVERAGE ENTIRELY. 



I UNDERSTAND THATTHE COV- 
ERAGE SELECTION AND LIMIT 
CHOICES INDICATED HERE WILL 
APPLY TO ALL FUTURE POLICY 
RENEWALS, CONTINUATIONS AND 
CHANGES UNLESS I NOTIFY YOU 
OTHERWISE IN WRITING. 



1. 1 SELECT UM AND UIM LIMITS INDIC IN THIS APP 
2. 1 REJECT UM BODILY INJURY COVERAGE 
3. 1 REJECT UIM BODILY INJURY COVERAGE 
4. 1 REJECT UM PROPERTY DAMAGE COVERAGE 
5. 1 REJECT UIM PROPERTY DAMAGE COVERAGE 



(APPLICANTS SIGNATURE) 
(APPLICANTS SIGNATURE) 
(APPLICANTS SIGNATURE) 
(APPLICANTS SIGNATURE) 
(APPLICANTS SIGNATURE) 




producer PHg^ 0iExt): (973)661-1500 
FAX "(973)661-9750 

DeBellis Insurance Agency, Inc. 
492 Franklin Avenue 
Nutley, NJ 07110 



CODE: I SUBCODE; 

00007675 



appucant URBAN MOVING SYSTEMS INC 

(First 

Named 

Insured) 



wmmmmmmm d ate{mm/dd/yy> & 
mmmmmzim 08/03/2001 ® 



EFFECTIVE DATE EXPIRATION DATE 

08/06/2001 J 08/06/2002 x 



DIRECT BILL 
AGENCY BILL 



PAYMENT PLAN 



FOR 

COMPANY 
USE ONLY 



nnnnV ,T* >** INTERNATIONAL V$& 

00006 2001: MDE| jj^jj^ ! vm . ihis6^01H393754 



v i„ v 1* 63, 964 

SIC FACTOR -SEATC'P: RADIUS FARTHEST TERM "' 



CITY, STATE, 21P 
WHERE GARAGED 



DRIVE TO WORK/SCHOOL j USE 



GVW/GCW 

25500 



: Y r rnmi-i = CHECK : 

: A : COMML : COVERAGES :_ 

I UNDER 15 MILES [ j PLEASURE \ j RETAIL |_X j UAB j 

I OVER 15 MILES j j FARM : j SERVICE I X j PIP 



j ADD'LPIP 

! MED PAY 

fv'i UNINS 
■ A : MOTOR 



■"Y*"1tlMBR'fiSIS" 

A MOTOR 
TOWING 

& LABOR 
SPEC 

COFL 



1ft [X 
:ftw : X 



JILSP iDEDUCTlBLisl ; A cv']'*X IcOMP i| fT 

.; 5 : * 2. : ■ «wl 

JCOMP [ JAA ^XJSTAMT [5 h 9.9.9. 

;Coll Is 63,964 fs 1,000 coll 



VEH# : YEAR 



MAKE: 



: BODY 
..:.n.PE:... 



j | MODEL: 

CITY, STATE, ZIP 
WHERE GARAGED 

DRrvifowo^ 

| UNDER 15 MILES [ ] PLEASURE 
I OVER 15 MILES I I FARM 



TERR "! GVW/GCW" 



: COMM*L | COVERAGES:.. 



; RETAIL 
j SERVICE 



:UAB 
: PIP 



j ADD'LPIP 

| I MED PAY 

: : UNINS 

: ■ MOTOR 



"UNDRTNS" 

MOTOR 
" TOWING 

& LABOR 

SPEC 

COFL 



CLASS 

If i 

«: >•■ 

Ift I 

;FTW; 



! SYM/AGE | COST NEW 
i • 

| [S 

'sic'T'"'^ 

"elsp rbWuSraijEsT i'^'\ Toowii" :"3!B? 



j COMP ^ | AA 

! coll ! $ 



jACV j |COMP : COFL 

j STAMT j $ 

l$ COLL 



VEH* 



YEA * iMAKE: 

> * 

: MODEL: 



: BODY 
: TYPE: 



CITY, STATE, ZIP 
WHERE GARAGED 

DR^TOWORraSCHOOLTuSE 

! UNDER 15 MILES j I PLEASURE 

j OVER 15 MILES j I- FARM 



TERR* j GVW/GCW*' 



TcOMWL'TcO^RAGEsi I ADD'LPIP MOTOR^ 

"1 I *: * * TOWING 

: RETAIL j : UAB = ;MEDPAY &LABCR 

1 ,™„„*. ! 1 «.« ? I UNINS SPEC 

: SERVICE j ; PIP ; j MOTOR COFL 



CLASS 
IF l 

Ift i 

4 >■• 

I FTW I 



• SYM/AGE : COST NEW 

• i j 

Sic '-"FACTOR" TSEATW 



Jls'p j^?"™^^^^ 

I STAMT I $ 



j COMP ; i AA 
j COLL j $ 



: $ 



COLL 



VEH# ; YEAR I^jmawb 

\ 1"°.!?^. 

CITY, STATE, ZIP 

WHERE GARAGED * 

DJ^TOWORiwCHOoUuSE • 

I UNDER 15 MILES \* \ PLEASURE 

JOVER15M1LES j I FARM 



•BODY 
j.TYPE: 

I vm: 
T""terr""| gvw/gcw" 



> Mm ■■hi • CHECK • 

J COMML ; COVERAGES;. 

j RETAIL I | UAB | 



: SERVICE 



: PIP 



*!*";"""""■ ONDWHS'T* 

: ADD'LPIP MOTOR •. 

":,. mD . v TOWING :" 

: MED PAY & LABOR : 

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j ftw I j coa ; $ j $ COLL 



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JUL 12 2001 3:22PM 



[-^LASERJET 3200 



P-l 



New Jersey Headquarters 
3 r 18 th Street 
Weehawken, NJ 07087 
.(201)568-0031 '* 

03J5T 



Urban Moving Systems, Inc. 



New York Headquarters 
446 West 50 m Street 
New York, NY 10019 
(212)338-9267 



DeBellis Insurance Agency, Inc. 
VIA FACSIMILE: 973-661-9750 

Re: Insurance proposal 



Dear 



Please review the fallowing and call me to let me know if you need anything else. 



be 

b7C 



Thank you, 






* 4 Jo Ouo+e 
• CPKG - 8fc*R 



$%,&£. 



ALL nTFOHMATIOlSr COOHTfl 

"ota^f/mSn by ft^^$M>fifa 




JUL 12 2001 3:22PM H 

06/25/01 HON 14:35 FAX 1 61 






J_RSERJET 3200 
2 9200 BSC 




p. 2 
@001 




Baldwin Sadler Corporation 
dba-CA^Baldwin Sadler Insurance Services 
National Managing Speciality Underwriters 
CA License OB01356 . 



June 25, 2001 



c?0/-SSV-0<PtS~ 



P0 Box 7001 

Royersford t PA194BB0B41 
(610)792-9100 (880)2279040 
[6101792-9200 



uroan Moving Systems, Inc. 
3 18TH STREET 
WEEHAWKEN, NJ 07087 



Re: Urban Moving Systems, Inc. 

(IHZ5623720; 16-AUG-00to 16-AUG-01] 



Dear 



be 

b7C 



Baldwin Sadler Corporation is a national managing specialty underwriter for 
cargo insurance for The Hanover Insurance Company. 

We have had no reported claims on the above captioned policy as 
of June 25, 2001. c 



Sincerely, 



COPY 



*&*• 



JUL 12 2001 3:22PM 



H|^L 



LRSERJET 3200 



p. 3 



Transmit.txt 



1 PAGE 



LOSSES AS OF: 06/30/2001 ACROSS ACCOUNTS - BY ACCOUNT „ 
RUN DATE: 07/05/2001 RMD DETAIL LOSS RUN 



4J 



INSURED:URBAN MOVING SYSTEMS INC PRODUCER: 0004 J REPORTING OFFICE: 

r 

POLICY NUMBER: UB 688X6573 ACCIDENT PERIOD FROM: 01011990 TO 070520 



01 

CLAIMANT ACCIDENT 0/ CLAIM 

INJURY CLASS FILE NUMBER 

DATE C AMOUNT 

CODES CODE AD J PRE- CLAIM 
POLICY EFF. DATE: 09/18/2000 

NO CLAIMS FOR THIS POLICY PERIOD 
STATE: 







AGE 



MEDICAL 
AMOUNT 



*TOTAL STATE 


NO. 


CLAIMS 









OPEN 









CLOSED 


















*TOTAL POLICY NO. CLAIMS 







LOSSES AS OF: 06/30/2001 ACROSS ACCOUNTS - BY ACCOUNT 
RUN DATE:07/05/2001 RMD DETAIL LOSS RUN 



Injury Code: 
r' of "CKe"* 

D-Death 
nder which the 

P-Permanent Disability 
compensation 

M-Major Permanent Disability 

N-Minor Permanent Disability 

T-Temporary Total or Temporary Partial 
ave 0000 until 

X-Medical Claims ' ■ 
Eff Date 

7-Contract Medical or Hospital 

8-Closed Death Cases in CA 

Page 1 



Class Code: The code numbe 
manual classification u 
employee is covered for 

Prefix CM claims will h 
18 months after Policy 



JUL 1^; 2QJ311 3:22PM (^LASERJET 3200 ^ p. 4 



^ - 

Transmit.txt 
9-Permanent Partial not in CA f TX, or Ni 
O-Hospital Reimbursement in CA 

0/C - Open or Closed Indicator ^ % 

1 PAGE * 1 * *" * li 

Selection Criteria for: 01-RMD DTL LOSS RUN 
Member Name:Q6360Q01 . Runtime: 15. 57.36 
Parm Name: Parm Desc: 

IF ACCJ5ATE FROM 01011990 TO 07052001 
IF POL_NBR EQ 688X6573 
Format: 

Current or History Selection was: C 

The Type of Dollars Reported was: 
Claim Size Option: 
Report Title ««> 

Sort Fieldl: Heading:, 

Sort Field2: Heading: 

Sort Field3: Heading: 

Variable Selection Statements: 

> 

> 

> 

> 

> 
> 

> 
> 
> 
> 
> 

> 
> 
> 
> 
> 



Page 2 



DEBELLIS INSURANCE AGENCY, INC 

492 FRANKLIN AVE . 

NUTLEY, NJ 07110 

973-661-1500 
FAX 973-661-9750 



FACSIMILE TRANSMITTAL SHEET 



TO: 



COMPANY: 

Urban Moving Systems 



FAX NUMBER: 



PHONE NUMBER: 



FROM: 



DATE: 

08/01/01 



TOTAL NO. OF PAGES INCLUDING COVER: 

01 



SENDER'S REFERENCE NUMBER: 



bo 
b7C 



RE: 



YOUR REFERENCE NUMBER: 



COMMERCIAL AUTO 
QUOTATION 



NOTES/COMMENTS: 

Per our conversation today please be advised I have obtained the following quotation on 
your commercial autos: 

Liability Limit $1,000,000 

Comprehensive & Collision Deductible $1,000. 

Total Annual Premium = $40,292 

Deposit Required to Bind = $10,073 (the balance of the premium can be financed on 9 

monthly installments) 

This indication is based on 7 units with total values of $159,662. 

The quotes for the Cargo, Warehouseman's Liability, and WC will be obtained shortly. 

If there are any questions please contact my office. 




"sssgEl***, 




RUG 10 2001 12:32PM HflM-ASERJET 3200 



\QM_t 



P-l 



New Jersey Headquarters 
■ 3 18 th Street 
-Weehawken, NJ 07087 
(201)558-0031 



Urban Moving Systems, Inc. 



New York Headquarters 
446 West 50 lh Street 
New York, NY 10019 
(212) 338-9267-,. 



noholllc InQiirgnno 

VIA FACSIMILE: 973-661-9750 



be 

b7C 



Dear i 

The informaion you requested is below, 
way. 



Please call me to confirm that you received them and that the application is on it's 



Thank vnn. £_ 



Urban Moving Systems, Inc. 



MC 320465 
NYSDott-33739 
US Dot 691256 
PC 0076006 



MC 398463 
USDOT 923345 



ALL WFOBMATXm CONTAlS* 



JUL 12 2001 3:23PM 



HWtL 



RSERJET 32Q0 



p. 12 



Drivers 






bss^mbmB 









3SfeEJ5g! 



IP 



bo 
b7C 



u 



Urfwr Houin 



.,-' 



\n%«.. ■■■,«***»,: 






RUG 02 2001 10:23nM 

URGttfT 



LHSERJET 3200 



p.l 



New Jersey Headquarters 
3 18 ,h Street 
Weehawken, NJ 07087 
(201)5§8^)031 

Slo'i- Si^-o^i? Pax 



Urban Moving Systems, Inc. 



New York Headquarters 
446 West 50 th Street 
New York, NY 10019 
(212) 338-9267 



DaBellls Insurance Agency, Inc. 
VIA FACSIMILE: 973-661-9750 



be 

b7C 



Dear 

Here is a rev i sed W of trucks that we rfeed covered by our policy. I apologize for the mix-up. Please give me a call so we 

can go over the details. 



JThanlfunn S\ 



urcan Moving systems, inc. 



Revised Vehicle Schedule 




2000 



GMC 



1999 



1994 



1993 



NTERNATIONAL 



INTERNATIONAL 



FORD 



2001 



FREIGHTUNER 



6 2001 



INTERNATIONAL" 



Van 



TRUCK 



TRUCK 



TRUCK 



TRUCK 



TRUCK 



1GCEG15W4Y1 142815 



1HTSCAAM5X6750B7 



1HSDPPN9RH559152 



1FDNK72CXPVA20054 



1 FVABPAL91HH68277 



1HISCAAM01H393754 



20.935.00 



$ 42,259.00 



26,000.00 



$ 15,000.00 



$ 69,837.21 



$ 63,964.60 



/ 

J 

J 



GW 



3l5, 50C> 



JOJL INFOEMATIOKr CONTAE3EQ* 
EEREmmimpLASSlHED „ A .. , 



«& 



>• 



<& 



^\ Wl«-- *.4T1,«WS,«-. 



JUL 12 2001 3:27PM HI^RSERJET 3200 

06/15/01 FR'r 09:43 FAX 516 eflUsCf 



p-22 
@002 




Urban Moving Systems inc 
3 lath Street 
Weehawken.NJ 07087 



Policy Number: 
Company: 
Effective Date: 
Expiration Date: 



Carriers Ins 
08/05/2001 
08/05/2002 




JUL 12 2001 3:28PM 



.LASERJET 3200 



p. 23 



Annual Receipts: $1,168,970.00 



* K 



Radius: 

• 90% 300 miles 

• 8% 120 miles 

• 2% 2500 miles 



piMuou ouiao wtfwUb. Gw^a^, 




: SjJmkQjX-^vWA 3> ^w^^fv 



T)M- Smxah mMe>> -0x&^ 



ALL INFORMATION CONTAINED 
HEREIN 15 UNCLASSIFIED 

DATE 07-30-2010 BY UC60322LP 



D&0 - %ap^xr) StuAfo, Goto 

" u z -tw om &Jd «x£ -to (Mh 




be 
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JUL 12 2001 3:28PM H^LRSERJET 3200 4fc p. 24 



ILL INFORMATION CONTAINED 
HEREIN 15 UNCLASSIFIED 

DATE 07-30-2010 BY UC60322LP/PLJ/CC 



Warehouse Insurance T^ 

\hjbOAL- Qua ujJlU 



Square footage: 16,000 



. Construction: concrete cinder blocks 
Total value of items stored: $250,000 
Security: closed circuit t.v. system and audio recording 
Who has access: warehouse personnel, storage manager 

Sprinklers: yes 

<: . 

Alarm System: ADT security linked to local police station 1 block 
from premises 



•bo 
b7C 



"&** 



JUL 12 2001 3:29PM 



.LRSERJET 3200 



p. 25 



ALL "INFORMATION CONTAINED 

HEREIN 15 UNCLASSIFIED 

MTE 07-30-2010 BY UC60322LP/PLJ/CC 



481-0837 (09/99) 



.. HANOVER INSURANCE COMPANY 

Worcester, Massachusetts 



MOTOR TRUCK CARGO COVERAGE PART 

(12:01 A.M., standard time), forms a 



This endorsement, effective '" 8/16/00 
part of Policy No. IHZ5623720 



issued to 



Urban Moving Systems, Inc. 



by Hanover Insurance Company. 



bo 
b7C 



Authorized Representative 



l^S^T^ P ° liCy "**** T^ Read *• «*• P° Kc y care& % to determine 
ngnts, duties and what ia nr is nnf /w»m/4 J *««*«* 





Parti 




Parts II through 


□ 


Part'n 


D 


Partm 


D 


Part IV 


a 


PartV 


□ 


Part VI 


D 


PartVH 


□ 


PartVm 


□ 


PartDC 


□ 


PaxtX 


D 


Part XI 



Applies to All Insureds 
XI Apply Only if Checked Below: 
Spoilage or Freezing 

Owner's Goods Extension - Insured's Merchandise 
Owner's Goods Extension - Extended Coverage Period 
Specified Perils Including Theft 
Specified Perils Excluding Theft 
Theft From Locked Vehicle (Only). 
Reduced Theft Limit On Target Commodities 
Theft of An Entire Load (Only) 
■ Theft From "Unattended" Vehicle Exclusion 
Vehicle Alarm Warranty 



481-0837 (09/99) 



• Page 1 of 8 



JUL 4& ZOO* 3: 29PM 



.LRSERJET 3200 



p. 26 
WC 00 00 00 (A) 



CONTINENTAL CASUALTY COMPANY 

4 ML INFORMATION COHTAIHED 
HEREIN 15 UNCLASSIFIED 

DATE 07-30-2010 BY UC60322LP/PLJ/CC 



WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 

l and suBject to all terms of this policy ; we agree £4$ you as follows: 
GENERAL SECTION 



In return for the payment of the premium < 



A. The Policy 

This policy includes at its effective date the Infor- 
mation Page and all endorsements and schedules 
listed" there. It is a contract of insurance between 
you (the employer named in Item 1 of the Informa- 
tion Page) and us (the insurer named on the 
Information PageV The only agreements relating to 
■ this insurance are stated in this policy. The terms of 
this policy may not be changed or waived except by 
endorsement issued by us to be part of this policy. 

B. Who Is Insured 

You are insured if you are an employer named in 
Item 1 of the Information Page. If that employer is 
a partnership, and if you are one of its partners, you 
are insured, but only in your capacity as an em- 
ployer of the partnership's employees. 

C. Workers Compensation Law 

Workers Compensation Law means the workersor 
workmen's compensation law and occupational dis- 



ease law of each state or territory named in Item 
3.A. of the Information Page. If includes any 
amendments to that law which are in effect during 
the policy period. It does not include any federal 
workers or workmen's compensation law, any fed- 
eral occupational disease law or the provisions of 
any law that provide nonoccupational disability 
benefits. 



of 



E. 



State 

State means any state of the Unite<TStates 

America, and the District of Columbia. 

Locations 

This policy covers all of your workplaces listed in 

Items 1 or 4 of the Information Page;, and it covers 

all other workplaces in Item 3.A. states unless you 

have other insurance or are self-insured for such 

workplaces. 



PART ONE-WORKERS COMPENSATION INSURANCE 



B. 



A. How This Insurance Applies 

^This workers compensation insurance applies to 
"bodily injury by accident or bodily injury by disease. 
Bodily injury includes resulting death. 

1. Bodily injury by accident must occur during the 
policy period. 

2. Bodily injury by disease must be caused or ag- 
gravated bv the conditions of your employment. 
The employee's last day of last exposure to the 
conditions causing or aggravating such bodily 
injury by disease must occur during the policy 
period. 

We Will Pay 

We will pay promptly when due the benefits re- 
quired of you by the workers compensation law. 

We Will Defend 

We have the right and duty to defend at our ex- 
pense any claim, proceeding or suit against you for 
benefits payable by this insurance. We have the 
rfcnt to investigate and settle these claims, proceed- 
ings or suits. 

-We have no duty to defend a claim, proceeding or 
suit that is* not covered by this insurance. 
We Will Also Pay.- 

We will also pay these costs, in addition to other 
amounts payable under thisjnsurance, as part of 
any claim, proceeding of suit we defend: 
1. reasonable expenses incurred at our request, 
but not loss of earnings; 



2. 



3. 
4. 



premiums for bonds to release attachments and 
for appeal bonds in bond ( amounts up to the 
amount payable under this insurance; 
litigation costs taxed against you; 
interest on a judgment as required by law until 
we offer the amount due under this insurance; 
and 
5. . expenses we incur. 

E. Other Insurancte 

We will not pay more than our share of benefits and 
costs covered by this insurance and other insurance 
or self-insurance. Subject to any limits of liability 
that may apply, all shares will be equal until the loss 
is. paid, If any insurance or self-insurance is ex- 
hausted, the shares of all remaining insurance will 
be equal until the loss is paid. 
E. Payments You Must Make 

You are responsible for any payments in excess of 
the benefits regularly provided by the workers com- 
pensation law including those required because: 
1. of your serious and willful misconduct; 

you knowingly employ an. employee in violation 

of law; 

youllail to .comply with a health or safety law or 

regulation; or 

you discharge, coerce or otherwise discriminate 

against any employee in violation of the workers 

compensation law. 
If we make any payments in excess of the benefits 
regularly provided by the workers compensation 
law on your behalf, you will reimburse us promptly. 



2. 
3- 



4. 



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PARTI GENERAL TERMS AND CONDITIONS 

Throughout this policy, the words "you" aitd <t your" refer to 
the Named Insured shown in the Declarations. The words 
"we," te us" and "our** refer to the Company providing this 
insurance. 

This coverage part,, Part I, replaces the "Conditi^|$*ori the 
reverse of the Declarations Page (if any). 

Other *words and phrases that appear in quotation marks have 
special meaning. Refer to Section G - DEFINITIONS. 

A COVERAGE 

"We will pay for 'loss" to Covered Property from any of 
the Covered Causes of Loss. 

1. Covered Property, as used in this CoverageTcrrn, 
means property of others that you have accepted for 
transportation as a common or contract motor 
carrier under your tariff and bill of lading or 
shipping receipt issued by you, or as a contract 
carrier under contract. 

We cover property only while: 

a. contained in or on any land vehicle while in 
"transit?* "and/or during *loading" or 
"unloading;" or 

b. at premises. 

But, we cover property only at premises shown in 
the Declarations; coverage does not apply to" 
property for which a storage charge is made. 

2. Property Not Covered 

Covered Property does not include: 

a. accounts, bills, blueprints, currency, deeds, 
evidences of debt, money, notes, securities, 
cornmercial paper or other documents of 
value; 

b. bullion, gold, silver, platinum or other 
precious alloys or metals, jewelry, watches, 
precious or semiprecious stones or similar 
valuable property; 

c furs; 

d. paintings, statuary and other works of art; 

e. "intermodal*' containers, trailers or other 
carrying conveyance; 

f. live animals, birds or fish except as follows: ■ 

We only cover your liability for theft or death 
or destruction directly resulting from or made 
* necessary by fire, smoke, explosion, rioters, 
strikers, civil cornrnjotion, flood, or by 
collision upset or overturn of the vehicle 



carrying the property, if these causes cf "loss" 
would be covered under ihis Coverage Form; 

g. contraband, or property in the course of illegal 
transportation or trade; ■ 

>* :3k pads, tarpaulins, handtrucks, chains, tiedowns . 
■■* : -^| and similar equipment uscd^on or in 
connection with vehicles you owner operate. 

3. Covered Causes of Loss 

Covered Causes of Loss means your legal liability 
as a common or 'contract motor carrier, either as 
" imposed by law or assumed by contract, for Direct 
Physical "Loss" to Covered Property except those 
Causes of "Loss" listed in the Exclusions. 

4. Coverage Extensions 

a. Earned Freight Charges 

We cover your earned freight charges that ypu 
are unable to collect as a result of a "loss" 
covered by this Coverage Porm. The most we 
will pay in any one occurrence is $3,000. This 
limit is separate from the Limits of Insurance 
shown in the Declarations. 

b, Debris Removal 

(1) We will pay your -expense to 'remove 
debris of Covered Property caused by or 
resulting from a Covered Cause of Loss 
that oceans during the policy period. The 
expenses will be paid only if they are 
reported to us within 180 days of the 
earlier of 

(a) the date of direct physical "loss;" or 

* (b) the end of the policy period. 

(2) The most we will pay under this coverage 
is 10% of "the applicable Limit of 
Insurance for direct physical *loss" to 
Covered Property, up to a maximum of 
$6,000 for the sum of all such expenses 
for each occurrence. The Debris 
Removal limit is separate from the Limit 
of Insurance stated elsewhere in the 

* policy. 

c Reloading Expense " 

If Covered Property is spilled as a result of an 
accident to the conveying vehicle, we will pay 
your expense to reload the Covered Property. 
This coverage applies when there is no "loss" 
to the Covered Property. The mast we will- ' 
pay in any one occurrence is $6,000. This 
limit is separate from the Limits of Insurance . 
shown in the Declaration. 



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P-2 



The additional coverages for Debris Removal ' 
and Reloading Expenses do not apply to the 
cost to: 

(a) extract "pollutants" from land or 

•water; or 
\ ^ * ■ 

flb) rXmiave, restore or replace polluted 

land or •water. 



B. EXCLUSIONS 



I. We "will not pay your liability for. a "loss" caused 
directly or indirectly by any of the following. Such 
*loss" ia excluded regardless of any other cause or 
event that contributes concurrently or in any 
sequence to the "loss." 

a. Governmental Action 

Seizure or destruction of property by order of 
governmental authority. 

But we -will pay for acts of destruction ordered 
by governmental authority and taken at the 
time of a fire to prevent its spread if the fire 
would be covered under this Coverage Part. 

b. Nuclear Hazard 

(1) any weapon employing atomic fission or 
fusion; or 

(2) nuclear reaction of radiation, or 
radioactive contamination from any. other ■ 
cause. But we will pay for direct "loss" 
caused by resulting fixe if the fire would 
be covered under this Coverage Form. 

c. War and Military Action 

(1) war, including undeclared or civil war; 

(2) warlike action by a military force, 
** including action in hindering or. 

defending against an actual or expected 
attack, by any government, sovereign or 
other authority using military personnel 
or other agents; or 

(3) insurrection, rebellion, revolution, 
usurped power or action taken by 
governmental authority in hindering or 
defending against any of these. 

X We will not pay your liability for a "loss" caused 
by or resulting from any of the following: 

a* ■ delay, loss of use, loss of market or any other 
consequential loss. 

b. dishonest acts by you, your employees or 
authorized representatives (including operators 
. under contract to you). 



This exclusion applies whether or not such 
persons are acting alone or in collusion with 
other persons or such acts occur during the 
hours of employment. 

c. spoilage, deterioration, contamination, 
freezing, rusting, extremes of temperature, 
shrinkage, evaporation, loss -of weight, or 
change in flavor, finish or texture. 

But we will pay your liability for direct "loss" 
caused by fire, explosion, smoke, riot or civil 
commotion, vandalism or malicious mischief, 
theft, collision, flood, upset or overturn of the 
transporting conveyance. 

3. We will not pay your liability for a "loss" caused 
by or resulting from any of the following. But if 
"loss" by a Covered Cause of loss results, we will, 
pay for the resulting "loss." 

a. Weather conditions. But this exclusion only 
applies if weather conditions contribute in any 
way with a cause in event excluded in 
paragraph 1 above to produce the "loss." 

b. Wear and tear, any quality in the property that 
causes it to damage or destroy itself, insects, 
vermin and rodents. 

4. We will not pay for any costs or penalties yon incur 
for violation of any law or regulation that applies to 
your delay in payments, denial or settlement of any 
claim made against you by others for 'loss" to 
Covered Property, 

C. LIMITS OF INSURANCE 

1. The most we will pay for "loss" in any one 
occurrence. is the applicable Limits of Insurance 
shown in the Declarations. 

2. The most we will pay fox "loss" in any one 
occurrence to Race Horses, Show Animals,*or High 
Valued Breeding Animals is 150% of the 
commodity meat price per pound on the day of the 
"loss" on the Chicago Mercantile Exchange. 

D. DEDUCTIBLE 

We will pay only the amount of the adjusted "loss" in 
any one occurrence in excess of the Deductible amount 
shown in the Declarations, up to the applicable Limit of 
Insurance. 

E. GENERAL CONDITIONS 

The foUowing conditions apply in addition" to the 
Common Policy Conditions: 

1. Coverage Territory 

We cover properly within: 



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481-0837 (09/99) 



a. the states of the United States (excluding 
Alaska); 

b. Canada 

but we do nor cover any property in transit to or 
fomHawaii. 

2. Valuation 

Hie value of property will be the least of the 
following amounts: 

a. 1. the amount for which you are liable; 

2. the amount of invoice, or in the absence 
of an invoice, 'the actual cash value of 
tliat property as of the time of "loss;" 

b. the coat of reasonably restoring that property 
to its condition immediately before "loss;" or 

c. the- cost of replacing that property -with 
substantially identical property. 

In the event of "loss " the value of property vail be 
detearnined as of the time of "loss." 

3. Labels 

In the event "of "loss" only at the identifying labels 
or wrappers containing the Covered Property, we 
will pay the costto replace those labels or wrappers 
if the 'loss" is caused by or results from a Covered 
Cause of Loss. 

4. Concealment, Misrepresentation or Fraud 

This Coverage Part is voitTm any case of fraud, 
intentional concealment or misrepresentation of a 
material fact, .by you or any other Insured, at any 
time, concerning; 

a. this Coverage Part; 

b. the Covered Property; 

c. your interest in the Covered Property; or 

d. a claim under tins Coverage Part 

5. Legal Action Against TJs 

No one may bring a legal action against us under 
this Coverage Part unless: 

a. there has been fail compliance with alL the 
terms of this Coverage Part; and 

b. the action is brought within 2 years after you 
first have knowledge of the "loss." 

6. Records ^ 

You shall keep accurate records of your trucking 
business and all* "gross receipts" from transporting* \ 
the property covered by this Coverage Form. You 



shall retain these records for three years after the 
policy ends. 

- 7. Reimbursement to \Js 

We may endorse this policy at your request to' 
' comply with the requirements of the Interstate 
Commerce "Commission or any other governmental 
authority. . — 

If we pay any "loss" solely because of any such- 
endorsement, you will promptly reimburse us for 
that payment and any other expense we have in 
connection with, that payment. 

8. Adjxw tment and Payment of Loss 

At our option, we.,may adjust the "loss" with and 
pay to: 

a. you, for the account of whom it -may concern; 
or 

b. your customer, or the owners of the Covered 
Property. 

If legal actions are taken to enforce a claim against 
you, we reserve the right, at our option, without 
expense to you, to conduct and control your 
defense. This action will not increase our liability 
under your policy, nor increase the Limits of 
Insurance specified. 

9. No Benefit to Bailee 

No person or organization, other than you, having 
custody of Covered -Property, will benefit iiom this 
insurance. 

11*. Policy Period 

We' cover "loss" commencing during the policy 
period shown in the Declarations. 

11. Excess Insurance 

You agree that no excess insurance over and above 
the Limits of Insurance of this policy shall be 
provided by any other policy. 

F. LOSS CONDITIONS ' 

1. Abandonment 

There can be no abandonment of any property to 
us. 

2, Appraisal " 

If we and you disagree on .the value of the property 
or the amount of "loss " either may make written 
demand for an appraisal of the "loss"" In. this 
event each party will select a competent and 
impartial appraiser. The two appraisers will select 
an umpire. If they cannot agree, either may request 
that selection be made by a judge of a court having 



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481-0837 (09/99) 



jurisdiction. The appraisers will state separately 
the value of the property and amount of "Loss." If 
they fail to agree, 1hjey toII submit their difference 
to the umpire. A decision agreed to by any two 
will be binding. Each part will: 

a. pay its choseif appraiser; and 

b. bear the. other expenses of the appraisal and 
umpire equally. 

If there is an appraisal, we will still retain, our right 
to deny the claim. 

3. ■ Duties in the Event of Loss 

You must see that the following are done in the 
event of "loss" to Covered Property. 

a. Notify the police if a law may have been 
broken. 

V Give us prompt notice of the 'loss." Include a 
description of the property involved. 

c As soon as possible, give us a description of 
how, when and where the "loss" occurred. 

& Take all reasonable steps to protect the 
Covered Property from further damage. If 
feasible, set the damaged property aside and in 
merest possible order for examination. Also 
keep a record of your expenses, for 
consideration in the settlement of the claim. 

e» Make no statement that will assume any 
obligation or admit any liability, for any 'loss 1 ' 
for which wc may be liable, without our 
consent. 

f. Permit us to inspect the property and records 
proving 'loss." 

g. If requested, permit us to question you under 
oath, at such times as may be reasonably 
required, about any matter relating to this 
insurance or your claim, including your books 
and records. In such event your answers must 
be signed. 

h. Send us a signed, sworn statement of "loss" 
containing me information we request to settle 
the claim You must do this within 60 days 
after our request. We will supply you with the 
necessary forms. 

i. Promptly send us any legal papers or notices 
received concerning the "loss." 

j. Cooperate with us in the investigation or 
settlement of the claim 

k You must promptly make claim in writing " 
against any other .party who may be liable for 
the "loss."' 



4. Insurance Under Two or More Coverages 

If two or more of this policy's coverages apply to 
the same "loss," we will not pay more than the 
actual amount of the *loss." 

5. Loss 'Payment 

* We will pay or make good any Toss" covered 
. under this Coverage Part within 30 days after. 

a. we reach agreement with you; 

h. the entry of final judgment; or 

c the filing of an appraisal award. 

We will not be liable for any part of a "loss" that 
has been paid or made good by others. 

6. Other Insurance 

If you have other insurance covering the same 
."loss" as the insurance under this Coverage Part, 
we will pay only the excess over what you should 
have received from the other insurance. We will 
pay the excess whether you can collect on the other 
insurance or not 

7. Pair, Sets or Parts 

• a. Pair or Set. In case of "loss" to any part of a 
pair or set we may: 

1. repair or replace any part to restore the 
pair or set to its value before the "loss," 
or 

2. pay the difference between the value of 
the pair or set before and after the "16ss ." 

b. Parts. In case of "loss" to any part of Covered 
Properly consisting of several parts when 
complete, we will only pay for the value of the 
lost or damaged part, 

8. Privilege to Adjust with Owner 

In the event of "loss" involving property of others 
in your care, custody or control, we have the right 
to: ■ 

. • a. Settle the "loss" with the owners of the 
property. A receipt for payment from the 
owners of that property will satisfy any claim 
of yours. 

b. Provide a defense far legal proceedings 
brought against you. If provided, the expense 
of this defense will be at our cost and will not 
reduce the applicable Limit of Insurance under 
this insurance. 



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fcRSERJET 3200 



p. 5 



PART FOUR- YOUR DUTIES IF INJURY OCCURS 



Tell us at once if injury occurs that may be covered by 4 
this policy. Your other duties are listed here, 



A. 



C. 



D, 



E. 



Provide for immediate medical and other services 
required by the Workers compensation Jaw. 
Give us or our agent the names and addresses of the 
injured persons and of witnesses, and other infor- 
mation we may need. ^ 

Promptly give us all notices, demands and legal 
papers related to the injury, claim, proceeding or 
suit* 



5. 



Cooperate with us and assist us, as we may request, 
in the investigation, settlement or defense of any 
claim, proceeding or suit. 

Do nothing after an injury occurs that would inter- 
fere with our right to recover from others. 

Do not voluntarily m^ payments, assume'obTiga- 
tions or mcur expenses, except at your own cost. 



PART FIYE - PREMIUM 



Our Manuals 

All premium for this policy will be determined by 
our manuals of rules, rates, rating plans and classi- 
fications. We may change our manuals and apply 
the changes to this policy if authorized by law or a 
governmental agency regulating this insurance. 
Classifications 

Item 4 of the Information Page shows the rate and 
premium basis for certain business or work classi- 
fications. These classifications were assigned based 
on an estimate of the exposures you would have 
during the policy period, If your actual exposures 
are not properly described by those classifications, 
we will assign proper classifications, rates and pre- 
mium basis by endorsement to this policy. 
Remuneration 

•Premium for each .work classification is determined- 
by multiplying a rate times a premium basis. Re- 
muneration is the most common premium basis. 
Tins premium basis includes payroll and all other 
remuneration paid or payable during the policy 
period for the services or: 

1. All your officers and employees engaged in 
work covered by this policy; and 

2. All other persons engaged in work that could 
make us liable under Part One (Workers Com- 
pensation Insurance) of this policy. If yon do 
not have payroll records for these persons, the 
contract price for their services and materials 
may be used as the premium basis. This para- 
graph 2 will not apply if you give us proof that 
the employers of these persons lawfully secured 
their workers compensation obligations. 

Premium Payments 

You will pay all premium when due. You will pay 
the premium even* if part or all of a workers com- 
pensation law is not valid. 
Final Premium 

The premium shown on the Information Page, 
schedules, and^ endorsements is an estimate. The 
final premium will be determined after this policy 



F, 



G, 



ends by using the actual, not the estimated, pre- 
mium basis and the proper classifications and rates 
that lawfully apply to the business and work covered . 
by this policy. If the final premium is more than the 
premium you paid to us, you must pay us the- bal- 
ance. If it is less, we will refund the balance to you. 
The final premium will not be less than the highest 
minimum premium for the classifications covered 
by this policy. 

If this policy is canceled, final premium will be 
determined in the following way unless our manuals 
provide otherwise: 

1. If we cancel, final premium will be calculated 
pro rata based on the time this policy was in 
force. Final premium will not be less than the 
pro rata share of the minimum premium. 

2. If yon cancel^ final premium will be more than 
prq rata; it will be based on the time this policy 
was in force, and increased by our short-rate 
cancellation table and procedure. Final pre- 
mium will not be less than the minimum pre- ■ 
mium. 

Records 

You will keep^ records of information needed to 
compute premium. You will provide us with copies 
of those records when we ask for them. 
Audit 

You will let us examine and audit all your records 
that relate to this policy. These records include 
ledgers, journals, registers, vouchers, contracts, tax 
reports, payroll and disbursement records, and 
programs for storing and retrieving data. We may 
conduct the audits during regular business hours 
during the policy period and within three years 
after the policy period ends. Information developed 
by audit will be used to determine final premium. 
Insurance rate service organizations have the same 
rights we have under'this provision. 



PART SIX - CONDITIONS * 



Inspection 

We have the right, but are not obliged to inspect 
your workplaces at any time. Gair inspections are 
not safety inspections. They relate only to the insur- 
ability of the workplaces and the premiums to be 
charged. We may give you reports on the conditions 
we find. We may also recommend changes." While 



they may help reduce losses, we do not undertake to 
perform the duty of any person to provide for the 
health or safety of your employees or the public. 
We do not warrant that your workplaces are safe or 
healthful or that they comply with laws, regulations, 
codes or standards, Insurance rate service organi- 
zations have the same rights we have under this 
provision. 



Page 4 of 5 



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p. G 



. 5. Recoveries 

Any recovery or salvage* on a "loss" will accrue 
entirely to our benefit until the sum paid by us has 
'been made up. 

10. Reinstatement of Limit After Loss 

Tlie Limit of Insurance will not be reduced by the 
payment of any claim, except for total "loss" of a 
scheduled item, in which event we will refund the 
unearned premium on that item * 

11. p-ansfer of Rights of Recovery Against Others 
To Us 

If any person ^organization to or for whom we 
make payment under this- insurance has rights to 
recover damages from another, those rights are . 
fraiisferredtous. That person or organization must 
do everything necessary to secure our rights and 
must do nothing after "loss" to impair them. 

You may accept bills of lading or shipping receipts 
issued by other carriers that limit their liability to 
less than the actual value of the property. 

G. Definitions 

"Loss" means accidental loss or damage. 

"Gross receipts" means the total amount of receipts to 
which you are entitled for Hie packing, loading 
unloading and transporting of Covered Property 
regardless of whether you or another carrier originated 
&e transportation. 

"PoUutants" means any solid, liquid; gaseous or 
thermal irritant or contaminant including smoke, vapor, 
soot, fumes, acids, alkalis, chemicals and waste.* Waste- 
includes material to be recycled, reconditioned or 
reclaimed. 

"Transit" begins with the actual movement oflhe goods 
from the point of shipment bound for a specific 
destination. It remains in transit durmg the ordinary 
reasonable and necessary stops, intermptions, delays or 
transfers incidental to the route and method of shipment 
including rest periods taken by the driver(s). Transit 
finds upon acceptance of the goods by or on behalf of the 
consignee at destination, but shall not extend beyond 
168 hours following arrival at destination. 

'TntcraadaT containers arc containers used in 

corohmaticnwithanomermoaeoftrarisportatiOT such 
as trailer on flatcar. 

"Loading" means the lifting or moving of Covered ' 
Property from the ground, or a loading platform 
immediately adjacent to the transporting conveyance, 
onto the transporting conveyance. 

"Unloading" means the lowering or moving of Covered 
Property from the transporting conveyance to the 



481-0837 (09/99)* 

ground, or a loading platform immediately adjacent to 
the transporting conveyance. 

H. Cancellation 

This policy may be cancelled by the Insured by 
surrender thereof to the Company or any ,pf its 
authorized agents or by mailing to the Company written 
notice stating when thereafter such cancellation shallbe 
effective. . This policy may be cancelled by the 
• Company by mailing to the Insured at the address shown 
m this policy or last known address written notice 
stating when, not less than rive (5) days mereaftex such 
cancellation shall be effective. Ihe mailing of notice as 
aforesaid shall be sufficient proof of notice. Thetirrc of 
surrender or the effective date of the cancellation' stated 
m the notice shall become the end of the policy period 
Delivery of such written notice either by the Insured or 
by the Company shall be equivalent to mailing. 

If the Insured cancels, earned premiums shall be 
computed m accordance with the customary short rate 
. table and procedure. If the Company cancels, earned : 
premiums shall be computed pro 'rata. Premium 
agistment may be made at the time cancellation is 
effected and, if not then made, shall be made as soon as 
practicable after cancellation becomes 'effective. The 
Company's check or the check of its representative 
mailed or delivered as aforesaid shall be a sufficient 
tender of any refund of premium due to the Insured, 

I Changes 

Notice to any agent or knowledge possessed by any 
agent or by any other person shall not effect a waiver or 
a change in any part of this policy or estop the Company 
from asserting any right under the terms of thia policy ' 
nor shall the terms of this policy be waived or changed^ 
except by endorsement issued to form a part of this • 
policy, 

J. Conformity to Statute 

Terms of this policy which are in conflict with the 
statutes of the State wherein this policy is issued are 
hereby amended to conform to such statutes. 



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I 
1 

•Si 



PART II SPOILAGE OREREEZING 

We will pay for "logs" to -Covered Property caused by 
spoilage or freezing due to mechanical or electrical 
breakdown of refrigeration- or heating equipment, while on 
vehicles you own. or ^operate, subject to the following 
additional conditions: * 

We will not pay for spoilage or freezing due to: 

1. lack of fuel required to operate refrigeration or 
hearing equipment; 

2. disconnecting or unplugging refrigeration or 
heating equipment, or termination of power by 
turning off switches or similar devices; 

3. - failure to perform proper "maintenance" of the 

cooling . or heating equipment according to 
rnanufacturei's recommended schedule. 

"Maintenance" means: 

1, to inspect cooling and heating equipment by you 
or your qualified representative at least once 

. every 30 days; 

2, repair or replace equipment as necessary; 

3, record maintenance activities. These records will 
be available to us uponreqpiest 



PART m OWNER'S GOODS EXTENSION - 

INSURED'S MERCHANDISE 

We provide coverage for loss or damage to your lawful 
goods and merchandise. The property must be in your 
custody and actually in "transit," in or on vehicles operated 
by you. 

We do not cover your property while: . - 

1 /* in or on your premises; 

2. in any garage or other building where your 
vehicle(s) are usually kept 

Such merchandise shall be valued at amount of invoice, or 
in the absence of invoice, at market value on date and at 
place of shipment 

Our liability shall not exceed the limits specified in the 
policy declarations for 

1. the property of others for which you are legally 
liable; 

2. the value of your own goods; or 

3. both combined. 



PART IV OWNER'S GOODS EXTENSION - 

EXTENDED COVERAGE PERIOD 

• Coverage on your property attached upon "loading" and 
ceases when '^unloaded." 

ie Loading" means the lifting or moving of the Covered 
Property from the ground or loading platform immediately 
adjacent to the transporting vehicle onto the transporting 
vehicle. 

<c Unloading w means the lowering or moving of the Covered 
Property fiom the transporting vehicle to a loading platform 
or the ground immediately adjacent to the transporting 
vehicle. It is "unloaded" and coverage ceases' when 
property has been lowered to or placed upon the ground or 
loading platform. 

We will not cover property while it is being installed, 
erected or dismantled. 



PARTV SPECIFIED PERILS INCLUDING 

THEFT 

Clause A3. COVERED CAUSES OF LOSS is replaced 
by the following: 

Covered Causes of Loss means your legal liability as a 
common or contract motor carrier* either as imposed by law 
or assumed by contract for "loss" to Covered Property 
caused by or resulting from: 

1. fire, explosion, windstorm; 

2. collision of a cargo carrying vehicle with any 
other vehicle or object, excluding contact with 
any portion of the roadbed, or curbing, and 
excluding the coming' together of railroad cars 
during shifting or coupling; 

3. overturning of .the cargo carrying vehicle; 

4. collapse of bridges and culverts; 

5. stranding, sinking, burning or collision of any 
regular ferry or railroad carfloat (including 
general average and salvage charges for which 
you may be liable); 

6. ct fiood" means "loss" to property, but only while 
such property is in transit, caused by any of the 
following: 

a. the overflow of any body of water; 

b. the release of water impounded by a dam; or 

c. any rapid accumulation or runoff of surface 
water. 

7. theft of an entire shipping package. 



481-0837 (09/99) 



Page 7 of 8 






JUL 12 2001 3:34PM 



1 



LASERJET 3200 



.481-0837 (09/99)* 



p. a 



FART VI SPECIFIED PERILS EXCLUDING 

THEFT 

SrMLn? 7 ^ causes of loss -.^ 

commdaorcoirtractmotor carrier, either as imposed bylaw 
or assumed by contract for 'loss" to Covered Property 
cauaedbyorresultingfioxa: " -^ 

1 fire, explosion, windstorm; 

2. collision of a cargo carrying vehicle viifli any 
other vehicle or object, excluding contact with 
any portion of the roadbed, or curbing, and 
excluding the coming together of railroad cars 
during shifting or coupling 

overturning of the cargo carrying vehicle; 
collapse of bridges and culverts; 

stranding, sinking, burning "or collision of any 
regular- ferry or railroad cariloat (including 
general average and salvage charges for which 
you may be liable), 

"flood" means "loss" to property", but only while 
such property is m transit, caused by any of the ■ 
following: . 

a. the overflow of any body of water, 

b. thQ release of water impounded by a dam; or 

c any rapid accumulation or runoff of surface 
water. O 



P 'ART IX 



3. 
4. 

5. 



tf. 



PARTyE THEFT FROMLOCKED 

VEHICLE (ONLY) 

Sij? ? ot *s far - w> cm * ed ^ ** ° f c °^d 

Property from "unattended" vehicles -wfcich you own or 
operate, unless: J 

1. at the time of <W the doors, windows and 
compartments of the vehicle® were closed and 
locked; 

2. there are visible signs on the exterior of the 
vehicle that the theft wasaresult of forced entry. 



THEFT OF AN ENTIRE LO 4JD 
(ONLY) 



Theft coverage provided by your policy for Covered 
Property in or on vehicles is limited to "loss" caused by 
theft of aa entire carload, truckload, trailerload or 
container, excluding theft by your employees or authorized 
representative (whether ornot such person^are acting alone 
or in collusion^ith cthcrpersons or such acts occur durin fi 
the hours of employment). S 

PARTX THEFT FROM "UNATTENDED" 

VEfflCLE EXCLUSION 

We will not pay for "loss" by theft of Covered Property 
from an Wtended*' ve&cle winch you own or operate 

2^ n f^[ max f^ ehi ^ without apeison on or in 
the vehicle, whoae duty is to-safeguard the vehicle and its 



PARTXI ' VEHICLE ALARM WARRANTY 

We will iurf pay for any "loss" caused by theft of Covered 
woperty tram vehicles owned or operated by you, unless: 

I. tiie vehicle(s) are equipped with a Theft Alarm 
" System; 

this alarm equipment is maintamed in good 
wkrng order at all times and inspected and 
approved at least once each 60 days by the 
marnifacturer, or any of its authorized 
representatives, and proper inspection certificates 
issued; 

the alarm equipment protecting the cargo 
compartment of each vehicle ia in the "02?' 
position, while merchandise is in the 
compartment, except while being loaded or 
unloaded; 



2. 



during loading and unloading, at least one 
employee will attend the cargo compartment to 
guard the contents. 



PART VET REDUCED THEFT LIMIT ON 

TARGET COMMODITIES 

The most we will pay for loss" caused by theft of 
, alcoholic hever^ (other thaa beer and Wx dru^slnd 

Spacco products, and p mri a,. b metalft ^d a in^jT^^ 
»25,G00 many one "less.'* «rf -. 



481-0837' (09/99) 



Page 8 of 8 



JUL 12 2001 3:35PM 



LRSERJET 3200 



p. 9 



B* Long Term Policy 

If the policy period is longer than one year and six- 
teen days, all provisions of this policy will apply as 
though a new policy were issued on each annual 
anniversary that this policy is in force. 

C. Transfer of Your Rights and Duties 

Your rights or duties under this policy may not be 
■transferred without our written consent. 
If you die and we receive notice within thirty days 
after your death, we will cover your legal repre- 
sentative as insured. 
Cancelation 

L You may cancel this policy. You must mail or 
deliver advance written notice to us stating 
when the cancelation is to take effect, 



2. 



D. 



4. 



We may cancel this policy. We must mail or 
deliver to you not less than ten days advance 
written notice stating when the cancelation is :o 
take effect. Mailing that notice to you at your 
mailing address shown in Item 1 of the Infor- 
mation Page will be sufficient to prove notice. 
The policy period will end on the day and hour 
stated an the cancelation, notice. 
Any of these provisions that conflict with a law 
that controls the cancelation of the insurance in 
this policy is changed by this statement to com- 
ply with the law. 
Sole Representative 

The insured first named in Item 1 of the 
Information Page will act on behalf of all insureds 
to change this policy, receive return premium, and 
give or receive notice of cancelation. 

Injrftness yhereof, the company has caused this policy to be signed by its President and Secretair at Hartford 
Connecticut, and countersigned on the information page by a duly authorized agent ofthZm^ ' 




b6 
b7C 



n ^ WC 00 00 00 (A) 



ALL INFORMATION CONTAINED 
.HEREIN 15 UNCLASSIFIED 

'DATE 07-30-2010. BY- UC60322LP/PLJ/CC 



CP-3349 Edition 2-92 Printed in U.&A. .(12-94) 



.-Includes copyright material of the National Council on 
Compensation Insurance, used with its permission. 
©1991 National Council on Compensation Insurance." 



013013 



Page-5of5 



JUL 1,2; 2X10:1 3:35PM I^LRSERJET 3200 A p. 10 



• 



ALL IHF0EHA.TI0N COHTAIHED 
HERE II IS UNCLASSIFIED 
CJNIPi MTE 07^0-2010 BY UC60322LP/PLJ/CC 

WORKERS COMPENSATION 

AND 

EMPLOYERS LIABILITY POLICY 

TYPEAR 



For Alt tka Commitments Yon ittka* 



INFORMATION PAGE WC 00 00*0* ( A) 

POLICY NUMBER: (6S59UB-674X651-5-00) 
W TAX IDENTIFICATION NO.: 223511891000 NEW-Oo" 

INSURER: CONTINENTAL CASUALTY COMPANY ■ 

1. INSURED- NCCI CO CODE: 10243 

PRODUCER: 

«« mo. systems IN o 4 , roEmLlttNN , co INC 

WEEHAWKIN n/o70 8 7 . ™ ™™ "•» 

MANHASSET NY 11030-4308 

Insured Is a corporation 

Other work places and Identification numbers.are shown in the schedule® attached. 
2. The policy period is from 09-18-00 to 09-18-01 12:01 A.M. at the Insured's mailing address, 
" ^ S^5ra™ l S WMdE! Part0 - of ^P°'^ a PP"estotheWor ke rsCom P e n . 



NJ 



Bodily mjory by Dtoee:-, / ,00000 E&m'&yee .. • 
C. OTHER STATES IteUMNCB Part Three of the policy applies to it. state,, .any, Ifetedhere: 

COVERAGE EXCLUDED. 



*S D ' This P° ,ic V' inc,ud es these endorsements and schedule's: 

' S SE * LISTIN( ? QF ENDORSEMENTS - EXTENSION OF INFO PAGE 

45 4 ' I!l B P re ^ iumf ° r ' h t polic y wi,lb . edetemiine d by our Manuals of Rtfes. Classifications Rates and Ratine 

.Sf Plans. Ail required Information is subject to verification and change by mjdSSS^SS^^ 



DATE OF ISSUE: 10-20-00 H* „..„.., 

OFFICE: CNA ' .040 " .ST ASSIGN: Nd 



PRODUCER: A E GOETTELMANN &-CO INC 



. ! 
I 



01 3014 



725LW ■ . . j' 



JUL 12 2001 3:36PM 



.LRSERJET 3200 



p. 11 



far AI7 th» CemmilmonU You JUj*«* 



WORKERS COMPENSATION 

AND 

EMPLOYERS LIABILITY POLICY 



EXTENSION OF INFO PAGE -SCHEDULE- WC 00 00 01 ( A) 
■ POLICY NUMBER: (6S59UB-G74X651 -5-00 ) 



INSURER; CONTINENTAL CASUALTY COMPANY 
INSURED'S. NAME: URBAN MOVING SYSTEMS INC 
EXP. MOD, EFFECTIVE DATE: 09-18-00 



CODE 



CLASSIFICATION 
LOCATION 001 01 

FEIN '223511891 ENTITY CD 001 

MD R Xnw^I lFICATI0N N0 - : 223511891000 
URBAN MOVING SYSTEMS INC 

3. 18TH STREET 
WEEHAWKIN.'NJ 07087 

FURNITURE MOVING & STORAGE 
DRIVERS . ' 



W SS CLERICAL OFFICE EMPLOYEES NOC 



8293 
8810 



RATE BUREAU ID: 317266 



PREMIUM BASIS 

ESTIMATED 
TOTAL ANNUAL 
REMUNERATION 



236620 
IF ANY 



RATES 
PER $100 OF 
REMUNERATION 



1 0243-NJ 



ESTIMATED. 

ANNUAL 

PREMIUM 



9.*11 
.25 



21556 



TOTAL PREMIUM SUBJECT TO EXPERIENCE' MODIFICATION 

CONTINGENT EXP MOD: 1.356 MODIFIED PReSSm 

.* no./ £™ L . £ STIMATED ANNUAL STANDARD PREMIUM 

6.00% PLAN PREMIUM ADJUSTMENT PROGRAM (0942) 

. 2.90% PREMIUM DISCOUNT (0064) 

. EXPENSE CONSTANTS 0900} 

8.80% 0935 NJ SECOND INJURY FUND SURCHARGE 

-.TOTAL ESTIMATED PREMIUM 

DEPOSIT AMOUNT DUE 



21556 

29230 

29230 

1754 

848 

160 

2572 

32868 

32868 



013015 



DATE OF ISSUE; 10-20-00 HB 



ST ASSIGN; NJ 



SCHEDULE NO: 01 OF LAST 



JUL 12 2001 3:36PM W^ LASERJET 3200 ^k o p. 12 



% 



OVA 

rbrAtt IheCommitottxrttYou Maka* 



WORKERS COMPENSATION 

AND 

EMPLOYERS LIABILITY POLICY 

n - " .. ENDORSEMENT WC 00 04 12 (00) 

POLICY NUMBER: (6S59UB-674X651 -5-00 ) 

CONTINGENT EXPERIENCE 
RATING MODIFICATION FACTOR ENDORSEMENT 

The premium for this policy will be adjusted by an experience rating modification factor. The factor shown in the 
schedule Is a Contingent | Experience Rating Modification factor based on the appropriate experience data available 
and supersedes any prior experience modification factor. We will issue an endorsement to show a revised factor 
If appropriate additional experience data becomes available. The Contingent factor will "apply unless a revised ' 
factor is subsequently issued. « ovi OBU 





. SCHEDULE 


STATE 


MODIFICATION 


NJ 


1 .3560 



DATE OF ISSUE: -10-20-00 ST ASSIGN: NJ 

013016 



JUL 12 2001 3:36PM 



LASERJET 3200 



p. 13 



OVA 

frMihtcmnHun^ti^u^f WORKERS COMPENSATION 

AND 
EMPLOYERS LIABILITY POLICY 

••- . • % ENDORSEMENT WC 29 04 07 (00) 

POLICY NUMBER: (6S59UB-674X651-5-00) 

NEW JERSEY PREMIUM DISCOUNT ENDORSEMENT 

(SCHEDULE X) 

wVST Je T y £? mlU ? f ° r thiS P0licy and the pollcies ' if an * listed in 'tem 2 of the Schedule may be elidible 
for a discount. This endorsement shows the discount rates in item 1 of the Schedule SiTi2 
prem.um discount will be determined by our Manual and your New JB^^SS!^2^£S!SlSSi 

ipe'cttfrathglluTh caTes ""* retr ° SPeCt,VS "*" ^ *" ° f the premiUm "^ not be sub J 6 « * «* 

So much of the New Jersey Standard Premium as is subject to retrospective rating shall not be subiect to 
discount. The remainder Is subject to discount and the discount is calculated as follows: 

(a) Determine the discount as though none of the Standard premium is subject to retrospective rating. 

(b) Determine thediscouot as though only the premium subject to retrospective rating is discounted. 

(c) The difference between (a) and (b) Is the applicable premium discount. 

SCHEDULE 

1 * £ REM i U ? P'SCOUM 1 "- The first $5,000 of the Standard Premium shall be charged In full without discount 

ToS^SS^S^^ t0 K S """"l* 3 - 5% ' the next $400 ' 000 sha " be «S«ta a distoun of 
o.o%, and the remainder shall be subject to a discbunt of 7.0%. 

2. OTHER POLICIES: 



<. 



v 



O13017 



DATE OF ISSUE: 1 0-20-00 ' ■ ST ASSIGN: 



NJ 



JUL 12 2001 3:36PM ^P LHSERJET 3200 



p. 14 



WORKSHEET FOR WORKERS' COMPENSATION TELEPHOMF rppodtim^ 

2SKP R H EM l MBERWHeN COMPlEniW WE .NFORMAT.ON below TELEPHONE REPORTING 

_D0 NOT DELAY IM CALLING !F YOU DO NOT HAVE ANSWERS TO ALL ™T H E QUEST.ON S 

ACCOUNT INFORMATION" 



CALlStS PHOHE NUMBSWSXTENSION 
( ) 



iwPLOYER'SNAME " 

PARENT CQMHANY/INSURED S NAME 



CALLER'S NAME (FIRST, MJ„ LAST) 



EMPLOYER'S ADDRESS (STREET. CITY. STATE & ZIP) ' 



CALLERS TITLE 



LOCATION CODE | NATURE OF BUSINESS. 



BENEFIT STATE 



EMPLOYER'S MAILING ADDRESS (STREET. CITY. STATE &.2P> 
□ SAME 



tMPLCYEE-SNAME (FIRST, MI. LAST) 



EMPLOYEE INFORMATION 



POLICY FORM POUCr NUMBER" 

C6S59UB-674X651-5-001 



tMPLOYEBS MAILING ADDRESS (SIREtT. CITY, STATE & ZIP) 



MARITAL STATUS! EMPLOYMENT STATUS CODE " 



D FULL-TIME OPART.TIMF 



NO. OF DEPENDENTS 



GENDER 

□ male D female 



SOCIALSECURrTY NUMBER 



'^LU^SHOMEADORESSTH E ^ 

Dyes Dno 



CLASS CODE | DATE OF BIRTH 



DATE OF INJURY 



TIME OF INJURY 



ACCIDENT INFORMATION 



WAGE PERIOD 



HOMEPHONE NUMBER 

( ) 



LOCAIIONS^ACaDg NT^ ^^ ^^^ 



DATE CLAIM REPORTED TO EMPLOYER 



WAS THE ACCIDENT ON THE bMPLOYER'S PREMISES" 

D YES D NO 



UID EMPLOYEE LOSE 
ANYTIME FROM WORK? 

□ YES D NO 

. DATE DISABILITY BEGAN 



,:'f ^f^ .^ BACK AT W0R K?'F Y£s . PATE RETURNED 



| DATE DISABILITY ENDED 



FULL DESCRIP HON OF ACCIDENT 



IS /WAS EMPLOYEE'S 
SAURY CONTINUED? 

□ YES □ NO 



DATS EMPLOYEE LAST WORKED 



COUNTY 



WAS EMPLOYEE'S INJURY RELATED 
TO A COMPANY-SPONSORED EVENT? 

□yes Dno 



WAS EMPLOYEE PAID 
FOR DATE OF INJURY? 



Dyes Dno 



DATE EMPLOYEE LAST PAID 



WAS ACCIDENT FATAL? IF YES DATE OF DEATH 

□ yes D NO 



CAUst o.= ACCIDENT (EG.. SUP/FALL, LIFTING, CHEMICAL) 



CONTRIBUTING FACTORS 



IF OTHER PARTIES WERE INVOLVED 
NAME (FIRST, MUAST) 



FMO.uk vtmuj- ACCIDENT, DRIVE R'S LICENSE NUMBEK STATE WHERE ISSUED 



EQUIPMENT, MATERIAL OR SUBSTANCE I WOLVED ' 



ADDRESS 



PHONE NUMBER 



WEKfc iJAhtGUARDS PROVIDED?' 

Dyes Dno 



WITNESS INFORMATION 
NAVE (FIRST. ML LAST) 



DESCRIPTION OF SAFEGUARDS 



WERE SAFEGUARDS USED? 

Dyes Dno 



ADDRESS 



PHONE NUMBER 



sb=s PART OF BODY INJURED (E.G. HEAD. NECK. ARM. LEG} 



===== CUMULATIVE INJURY? IF YES. LENGTH OF EXPOSURE' 

lis Dyes Dno 



C^aS^PLY) NAM5 ^ST.^LAST, 



INJURY INFORMATION 



NATUHb L* INJURY (EG. FRACTURE. SPRAIN. LACERATION) 



NATURE OF DUTIES 



PRSVOUS RELATED 
CONDITION? 



NO 



□ yes D 



D first aid - 



WHATTYPE OF FIRST AID WAS ADMINISTERED? 



PRE-EXISTING MEDICAL CONDmON(S) 



LENGTH OF TIME DOING ACTIVITY 



1ST DAY OF TREATMENT 



_. HOSPITAL/ 

U CLINIC - 



NAME AND /U3DRESS (STREET. CITY, STATE S ZIP) 



NAME AND ADDRESS (STREEI*. CITY, STATE & ZIP) 



D PHYSICIAN- 



TREATMENT 



O130ia 



PHONE NUMBER 
( )■■ 



MJNTCG9S 



TREATMENT 



LENGTH OF STAY 



SPECIALTY 



1 ST DAY OF TREATMENT 



1ST DAY OF TREATMENT 



CONTINUED ON REVERSE SIDF I 



JUL 12. J20Q1 3 : 37PM 



LflSERJET 3200 



p. 15 



WORKERS' COMPENSATION - FIRST REPORT OF INJURY - STATE SPECIFIC QUESTIONS 



Alabama 
Employee's county 

Employer's 10 (U.C. Account) Number 
•Specific product (e.g., tires) 



Alaska " ~ 

Side of body affected (left or right) * ** 

Employer's Alaska address (if different from mailing address) 

Date and time employee reft work 

Scheduled days off 

Time workday began 

Was accident caused by failure of a machine or product? 

f ir^iry was caused by a mechanical part, specify part 

If the accident was caused by anyone besides employee, gfre name 

and address 
If fatal, name and address of dependents 
If you doubt validity of claim, state reason 
Alaska Unemployment Insurance Account Number (U.I. Acct No.) 



Arizona ~~" ~~" r ™ ' 

Last date of work after injury 

Number of days per week company usually works 

Department number 

If validity of claim is doubted, state reason 

If another person not employed by company caused accident give 

name and address 
Was worker in your employ when injured? 
Hours per day employee worked the day of injury 
Will work loss exceed 7 days? 

Was injured paid for the day of Injury? (if yes, specify amount) 
Was employee-hired for permanent employment? 
Number of months employment available during the year 
Is employee furnished lodging or board? (If yes, specify value) ■ 
Does employee claim dependents? 
Actual gross earnings of employee'for the 30 calendar days 

preceding injury 
Is employee paid other than fixed weekly or monthly salary? 
£>oes employee earn extra pay for overtime? (If yes, basis of 

payment/hourly amount) 
Number of hours overtime considered normal per week 
Has injured been employed for more than 12 months? 
Gross wages of employee during 12 months preceding injury (Trom- 

thrpugh/amoum) 
Gross wages of employee from date of hire through date of accident 
Has employee received a wage increase within 12 months prior to 
injury? (If yes, specify date, wage/per before and wage/per after 

Gross earnings from date of increase through day prior to injury 
Was employee in overtime when injured? 



California " * r ~~~ ~~ 

State Unemployment Insurance Account Number 
Type of employer (private/state/cKy/county/schoof district/other 

government) 
Was employee unable to work for at least one fujl day after the date " 

of injury? 
Date employee was provided claim form 



Colorado . : "* 

How long has employee worked Tor this employer? 
Employee's fength of experience at this assignment 
Years of education completed (6 to 20) 
Number of employees 

If employee has not returned to work, estimate date of return 
Did injury occur because of intoxication, failure to use safety 

devices, failure to obey rules? 
Will benefits continue during disability? * " - 

If employee's health insurance benefits discontinue, what will the 

weekly cost be for continuing such benefits? 
If fatal, give name, relationship and address of closest dependent of 

deceased . 

Is employee receiving overtime, commissions or piecework? 



Connecticut 
Reason fer-report (lost iime/medical-health carefcccupational 

disease/correct prior report) 
Time employee's workday began 
Extent of accident/health and life coverage for employee 
For Occupational Disease£^> % , 

Date of last exposure ^ ^ 

Date of diagnosis as occupational^ related 
Employer's Registration Number (CRN) 
Was employee treated in an emergency room? 



Delaware 
Employer's UC Reporting Number 
Empfoyee's county 
If employee has returned to.work. at same wage? 



District of Columbia 
if employee has returned to work, at what time? 
Was injured hired In DC? 
Was injured given Form #7 DCWC? 
Piece or time worker 



Florida ~™ — 

Time injury was reported 
Rale of pay /per 

Was physician/hospital authorized by employer? 
Does the employer agree with the description of accident? 
Did the employee knowingly refuse to use safety equipment provided 

by you, the employer? 
■ Did the employee request medical care? (If yes, did the employer 
provide medical care?) 



Georgia 
Specific products (e.g., tires) 



Hawaii 

Was employee furnished meals or lodging? 

Monthly salary 

Department of Labor Number 

Medical deductible 



Idaho : 

IF gratuities (tips/etc.) were received in the course of employment 

estimate weekly value * 

Length of time employed by you at this occupation 
If mechanical apparatus or vehicle caused injury, what part of it 

caused injury? 
Type of treatment (inpatient/outpatient) 
If fatal, name and address of nearestjelative - 
What was employee doing when the accident occurred? 



Illinois "~ 

Illinois Unemployment Compensation Number 
SIC Number 

Total number of employees at the location where illness or Injury 

occurred 
Was employee given Industrial Commission Handbook? 
Did incident result in occupational injury or occupational disease? 
What unsafe act by a person caused or contributed to the injury or 

illness? - ' 



Indiana 
Number of lost workdays to date 



Iowa 

Number of employees 

Was injury caused by failure to use safely equipment or observe 

regulations? 
If employee has not returned to work, probable length of disability 
Is the injury expected to produce permanent disability? 



013019 WUNTDG98 



Pagel of 4 



JUL 12 2001 



WORKERS' COMPENSATION - FIRST REPORT OF INJURY - STATE SPECIFIC QUESTIONS 



i ! 



Does the employee receive either piecework or commission? 
Does the employes declare tips as mccme? 
Enployers Account Number 

New Hampshire 

If underage 18, is there a Child Labor Employment Certificate on 

file? 
Was injured hired In New Hampshire? 
Piece or time worker 
Time disability began 
Has injured filed a Farm 8a WCA? 
Part of machine on which accident occurred? 
Kind of power {e.g., hand, foot, electrical, steam, etc.) 
Was accident caused by insured's faiiuf e to use or observe safety 

equipment or regulation? 
Probable length of disability 
If employee has returned to work, at what time? 
Federal I.D. Number, 

Has employee returned to full or light duty? 
Initial treatment (none, employer, emergency, hospitalized, 

outpalient, clinic or office visit) 
if employee Is a leased or temporary worker, client's business name 
Is there a managed care program? (If yes, name of provider) 
Is there a written safety program in force? 
Is there an active safety committee? 
Number of employees, full time and part time 
SIC Code 

New Jersey 
Number of employees 

Was employee unable to work on 'any day after the in^ry? 
SIC Number 
Employer's Registration Number 

New Mexico 

Federal ID Number 

NM Unemployment Insurance Number 

Does your business have a safety program? (If yes, specify admini- 
stered period - weekly/monthly/ annuallyfother - if other, specify) 

Highest educational level attained 

Total lost work days 

If occupational iflness, date diagnosed and description of diagnosis 
■ Was employee under the influence of drugs/alcohol? (Yes/no7 
unknown) 

New York . ~~^ 

Code Number 

NYS U.l. Employer Registration Number 

Total earnings paid during 52 weeks prior to date of accident 

(include bonuses, overtime, value of lodging, etc.) 
Dfd employer provide medical care? (If yes, when?) 
Has the injury/illness been previously reported on Form C-2.1? 
Indicate days of week that employee regularly works 
If fatal., name, address and relationship of nearest relative 

North Carolina 

Employer Code Number • 
Time disability began 

Kind of power (hand, foot, electrical, steam, etc.) 
Part of machine on which Injury occurred 
Was accident caused by injured^ failure to use or observe safety 
" equipment or regulation? 
Probable length of disability 
. Ifemployee has returned to work, at what time7 * 

North Dakota 

Will employee be off the job for five or more consecutive days? 
" Time employee left work due to this Injjry 
Time workday began on the day of injury 
If employee has not returned to work, estimate date of return 
Employee's gross lota) .earnings for the past 52 weeks 



List each dependent under age 18, or under age 22 if attending 

school, or incapable of self support (name, birth date and 

relationship) 
Exact location of injury (e.g., plant, department, building, etc.) 
Workers Compensation Account Number 
Season length On months) 

■% 

Ohio 
Time accident reported to employer 
Has employee ever filed a previous application for this injury? 
Has employee filed any other claims with the Bureau or Industrial 

Commission? ()f yes, specify claim number and body parts) 
Employee's county 
Employer's Risk Number 
if under your employ for less than 12 months prior to injury, list 

former employers, dates if employment, wages and number of 

weeks 

Oklahoma 
SIC Number 

Oregon 

Education (number of years completed, or GED) 

Side of body affected (left or right) 

Department regularly employed 

Type of employer 0ndlvidualfcorporation/partnership/o(her) 

Is worker an owner or corporate officer? 

Did injury occur during the course of employment? 

Was accident caused by failure of machinery or product?. 

Did someone (not worker) cause accident? 

Time worker left work 

Explain if number of hours per shift or week varies 

Scheduled days off 

Pennsylvania ■ 

Employer's Unemployment Compensation Reporting Number 

If employee has returned to work, at what wage? 

Employee's county 

If employee is under age 18, Certificate Number and occupation for 

which issued 
Did injury occur because of mechanical defect or unsafe act? 
Was employee amputated? 

South Dakota 

Federal ID Number 

Unemployment Number 

SIC Code Number 

Number of employees 

Is the employee an officer or partner? 

Time workday began 

Exemption information (employee/spouse/over 65/bltnd/other 

dependents) 
Does employee receive pay in kind? (If yes, explain) 
Type of treatment (outpatient, emergency room or in house) 
Injury Codes: 

Body part injured (2 digits) 

Cause of in^jry (2dtgits) 

Nature of injury (2digits) 

Tennessee 

Federal ID Number 

(f paid on other than a time basis, such as piece work or 
commissions, indicate method and actual average weekly earnings 

if board, lodging or other advantages were furnished in addition to- 
wages, state nature and estimated weekly value 

tf employee has returned to work, at what wage? 

If fatal, name and address of nearest relative 

Texas 

Federal Tax ID Number 

Does the employee speak English? flf no; specify language) 

Employee's mailing county 

If married, spouse's name 



O13020 WUNTDG98 



Page 3 of 4 



^^ 



JUL 12 2001 3:38PM 



'• 



RSERJET 3200 



p. 17 



POLICY NUMBER 


POLICY PERIOD 
FROM TO 


COVERAGE IS PROVIDED IN THE 


;CX10568264 


08/05/00 


08/05/01 


PROVIDENCE WASHINGTON INSURANCE COMPANY 




UW0032 04/95 



JUL 12 2001 3:42PM 



LRSERJET 3200 



p. 18 



POLICY NUMBER 



CX105S8264 



POLICY PERIOD 
FROM TO 



08/05/00 08/05/01 



COVERAGE IS PROVIDED IN THE 



PROVIDENCE WASHINGTON INSURANCE COMPANY 




JUL 12 2001 3:47PM 



• 



LASERJET 3200 



10 



p. 19 



POUCY NUMBER 



CXI0568264 



POLICY PERIOD 
FROM TO 



08/05/00 



08/05/01 



COVERAGE IS PROVIDED IN THE 



PROVIDENCE WASHINGTON INSURANCE COMPANY 




UW0034 0795 



r 



JUL, ,1:2 2G@3 3:51PM 



i 



LASERJET 3200 



p. 20 



11 



•POLICY NUMBER 



CX10568264 



POLICY PERIOD 
FROM TO 



08/05/00 



0iJ/05/01 



COVERAGE IS PROVIDED IN THE 



PROVIDENCE WASHINGTON INSURANCE COMPANY 




JUL 12 2001 3:55PM 



LASERJET 3200 



p. 21 



12 



PROVIDENCE WASHINGTON INSURANCE CO 
LOCATIONS SCHEDULE 



POLICY # CXI 05 68 2 64 
URBAN MOVING SYSTEMS, INC 
312 PROVONIA AVENUE #1 
JERSEY CITY, NJ 07302 



•» AGENT: A.E GOETTELMANN* £ CO. 
# 31001540 ~ 



Prems BIdg 
No. No. Street 

001 001 445 WEST BOTH STREET 

(LIABILITY ONLY) 

002 -001 3 18TH STREET 



City County 

NEW YORK 



WEEHAWKEN 

HUDSON 



St Zip 

NY 10019 



NJ 07087 



JUL 12 2001 3:55PM 



■kLRSERJET 3200 



POLICY NUMBER: CX10568264 
-FORM SCHEDULE 



p. 22 
COMMERCIAL POLICY 



Forms and Endorsements applying to this Coverage Part and made a part of this 
policy at time of issue: 



FORMS APPLICABLE TO ALL PREMISES AND COVERAGES 



Form 



Edition Description 



FORM SCHP 


12 


96 


FORM SCHL 


12 


96 


IL0017 


11 


85 


IL0023 


04 


98 


IL0183 


04 


98 


IL0208 


04 


98 


IL0268 


07 


00 


IL0935 


08 


98 



PROPERTY FORMS SCHEDULE 

LIABILITY FORMS SCHEDULE 

COMMON POLICY CONDITIONS 

NUCLEAR ENERGY LIABILITY EXCLUSION ENDT 

NEW YORK CHANGES -FRAUD 

NEW JERSEY CHANGES -CANCELLATION & NONRENEWAL 

NEW YORK CHANGES - CANCELLATION & NONRENEWAL 

EXCLUSION OF CERTAIN COMPUTER RELATED LOSSES 



o 



ILL INFORMATION CONTAINED 
HEREIN 15 UNCLASSIFIED 

DATE 07-30-2010 BY UC60322LP/PLJ/CC 



*s> 



'Page 1 of 1 



JUL 12 2001 3:55PM j& LASERJET 3200 A p. 23 

POLICY NUMBER: CX105G8264 . COMMERCIAL PROPERTY 

■FORM SCHEDULE 

Forms and Endorsements applying to this Coverage Part and made a part of this 
polxcy at time of issue: 

FORMS APPLICABLE TO ALL PREMISES AMD COVERAGES " * 

Form Edition Description 

CP0010 06 95 BUILDING AND PERSONAL PROPERTY COV FORM 
CP0090 07 88 COMMERCIAL PROPERTY CONDITIONS 
IL0003 04 98 CALCULATION OF PREMIUM 



FORMS APPLICABLE TO SPECIFIC PREMISES AND COVERAGES 

Form .Edition Description 

CP1030 06 95 CAUSES OF LOSS-SPECIAL FORM 
PREMS 002 BLDG 001 YOUR PERSONAL PROPERTY 



ILL INFORMATION CONTAINED 
HEREIN .15 UNCLASSIFIED 

DATE 07-30-2010 BY UC60322LP/PLJ/CC 



Page 1 of 1 



JUL ,1% 2QtJi; 3:55PM 



POLICY NUMBER: CX10568264 
.FORM SCHEDULE 4 



LRSERJET 3200 



p. 24 



COMMERCIAL LIABILITY 



Forms and Endorsements applying to this Coverage Part .and made a part of this 
policy at time of issue: 



FORMS APPLICABLE* TO ALL PREMISES AND COVERAGES 



Q 



Form 



Edition Description 



CG0001 


01 


96 


CG0001 


07 


98 


CG0104 


04 


97 


CG0163 


07 


98 


CG2147 


07 


98 


CG2147 


10 


93 


CG2149 


07 


98 


CG2160 


09 


98 


CG2620 


10 


93 


CG2621 


10 


91 


CG2624 


08 


92 


CG2649 


06 


99 


IL0003 


04 


98 


IL0021 


04 


98 


IL0021 


11 


85 


U9935 


07 


91 



COMML GENERAL LIABILITY COV FM (OCCURRENCE) 

COMM GEN LIAB COV FORM- OCCUR VERSION 

NEW YORK CHANGES -PREMIUM AUDIT 

NY CHGES COMML GENL LIAB COVERAGE FORM- 

EMPLOYMENT- RELATED PRACTICES EXCLUSION 

EMPLOYMENT-RELATED PRACTICES EXCLUSION 

TOTAL POLLUTION EXCLUSION ENDORSEMENT 

EXCL-YR. 2000 COMPUTER-RELATED/ELECTRONIC PROB 

NJ CHANGES - LOSS INFORMATION 

NY CHANGES - TRANSFOER OF DUTIES WHEN A LIMIT 

NY CHANGES - LEGAL ACTION AGAINST US 

NJ CHGES-COV FO LIABILITY FOR HAZARDS OF LEAD 

CALCULATION OF PREMIUM 

NUCLEAR ENERGY LIABILITY EXCL ENDT 

NUCLEAR ENERGY LIABILITY EXCL ENDT 

COMMERCIAL GENERAL LIABILITY 



ILL INFORMATION CONTAINED . 
HEREIN 15 UNCLASSIFIED 

DATE 07-30-2010 BY UC60322LP/PLJ/CC 



Page 1 of 1 



JUL 12 2001 3:55PM 



1 



LASERJET 3200 



p. 25 




$ 44,404 $ 86,574 URBANMOVING!$E$34 

$ 153,195 $ 184,331 URBANMOVING!$D$34 



ILL INFORMATION CONTAINED 
HEREIN 15 UNCLASSIFIED 

DATE 07-30-2010 BY UC60322LP/PLJ/CC 



JUL 12 2001 3:56PM 



• 



LRSERJET 3200 



p. 26 



insured Name: URBAN MOVING SYSTEMS INC 
Policy Number 6S59 UB 688X6573 

Policy Term: 09/1 8/2000 - 09/1 8/2001 
Audit Term: % , 09/18/2000-12/17/2000 



NJ 09/18/2000 001 01 



8293 01 
8810 02 



ANNUALIZED PAYROLL EXPOSURES 

FOR YEAR ENDED 12/31/00 

FURNITURE MOVING & STORAGE, 

DRIVERS 

CLERICAL OFFICE EMPLOYEES NOC 



SAI; 
Loc: 
Aud ID: 




&LL INFORMATION CONTAINED 



^EEEIN 15 UNCLASSIFIED 

PATE 07-30-2010 BY UC60322LP/PLJ/CC 



David MacGregor Co. 






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I 



DATE: 07-30-2Q 
CLASSIFIED BY 
(Rev. 08-28-2000) PEAS 01; 1.4 (C) 

DECLASSIFY OH: 07-30-2035 



m 



22LP/PLJ/CC 



ALL iifo: 
* HEKEII I 
i WHERE SHO* 




I COHTAIHED 

LASSIFIED EXCEPT 
0TIER1ISE 



SEGM^T 



FEDERAL BUREAU OF INVESTIGATION 



Precedence : ROUTINE 
To : Newark 

From: Newark 
C-9 

Contact 
UL 

Approved B; 

Drafted By: 
Case ID #: 
Title: R) 



Attn: 



Date: 09/17/2001 
IMA (Rotor) , Squad C-9 




b2 
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titoh 



Synopsis: J^AT^equest sub- files for to captioned investigation. 

Derived/From : G-3 
Declassify On: XI 

Details: $$|A>n 09/14/2001, Newark Division, with the 
assistance or the New York Office (NYO) , initiated an 
investigation predicated upon the detention of five (5) Israeli 
Nationals who may have possessed information about the terrorist 
incident targeting the "Twin Towers" of New York City's World 
Trade Center (WTC) . 

j^^i^he following sub-files are requested to serve 
as repositories for the investigative information developed on 
the five (5) Israeli Nationals described herein: 



Sub-file 



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b7C 



Investigation at Newark continues , 



J 



♦♦ 



CLASSIFIED] 

REASON: !.4( (L^r -^ 



WHERESHOWN OTHER 1 



bl 



<•# ^ .*^M* 



(Rev. 08-28-2000) 



'fc 



* ^<& 



*'* all ..information cohtaihed 

hereii 15 otcl1ss1fied except 
where shoot otherwise 



SECRET 



DATE: 07-30-2010 

CLASSIFIED BY UC60322LP/P1J/CC 

reason: 1.4 (cj FEDERAL BUREAU OF INVESTIGATION 

DECLASSIFY OH: 07-30-2035 



(SI 



Precedence : ROUTINE 

To : Newark 

From: Newark 
C-9 
ConftacLt : SA 

Approved By- 
Drafted By: 
Case ID #: ^f 
Title: yg^ 



Date: 09/17/2001 
Attn: Squad C-9 



Synopsis: 




b2 
b6 

b7C 



( K%l eport 



):>3 



(Pfo) 



Administrative: 




DerivedVtf'rom : G-3 
Declassify On: XI 

tt^The attached 



pursuant to a criminal subnnfina served on f 



Iwere obtained 



Details: ($/{$) On 09/14/2 001, Newark Division, with the 
assistance of the New York Office (NYO) , initiated an 
investigation predicated upon the detention of five (5) Israeli 
Nationals who may have possessed information about the terrorist 
incident targeting the "Twin Towers" of New York City's World 
Trade Center (WTC) . 



(^3®The attached 
to a criminal subpoena serv< 


were obtained pursuant 


sd on 





(j^QfO&ccording to the display windows of the 
telephones, tlie following telephone numbers correspond to the 
following individuals : 



a 

CLASS 

REASON 

DEetASSIFYON 



siMket 



b3 



b3 




W SECRET 

To : Newark fi-irwn. Mewark 

( £ ) Re-s £§<J J09/17/2001 



• 



bl 



b6 
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(w^r 



(presumably 
(presumably 
(NFI) 



Investigation at Newark continues 



♦♦ 




SEc&ET 

2 



FD-302 (Rev. 10-6-95) 

DATE: 07-30-2010 

CLASSIFIED BY UC60322LP/PLJ/CC 

REASON: 1.4 (c) 

DECLASSIFY OH: 07-30-2035 



ALL IIFORMATION COHTAIHED 
HEKEII IS UNCLASSIFIED EXCEPT 
WHERE SHOWN OTHERWISE 




W* ; 



FEDERAL BUREAU OF INVESTIGATION 



Date of transcription 09/12/2001 



born |_ 



]of 



I Union City, New Jersey, was interviewed at her 

residence. SEter being advised of the identity of the interviewing 
agent and the nature of the interview, she provided the following 



be 

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information. (U) 

Afte 

1 frQyn[ 

I born [ 



Aft er being sho wn nu mbered photograp hs of] 



Uj£lK[ 



(#4) and 

recognized r Uae_£I 
recognized 



Lkprnl 



(#3), 



photograph. [_ 



J (#5), I 



born 



UM2), 



stated she 



Jbelieved she . 



from standing in line for the bus at the Port 



Authority in New York, New York.^.) 

Lead covered for control number 1148. (juC^ 




DAI 

CLASS 
REASON: 1.4j 



SSSs^sfSte^ 



ALLir 

HEREIN jSUNCB^SStEliD EXCEPT 



hi} 



investigation on 09/12/2001 at Union City, New Jersey 




Date dictated 09/12/2001 



bl 



This document contains neither recommendations nor rrmnlnsimjg of th ft FRT Tt is the nronertv of the FBI and is loaned to vour agency, 
it and its contents are not to be distributed outside your agency 



m 



,FD-302 (Rev. 10-6-95) 



ALL INFORMATION CONTAINED 

HERE II IS UNCLASSIFIED EXCEPT 

WHERE SHOOT OTHERWISE 



DATE: 07-30-2010 

CLASSIFIED BY UC60322LP/PLJ/CC 

REASON: 1.4 (C) 

DECLASSIFY ON: 07-30-2035 



FEDERAL BUREAU 




STIGATION 



Date of transcription 09/11/2001 



[ 



On 09/1 1/01, Special Agents (SA) 



and 



b6 
b7C 



interviewed Police Officer 



] of the F ederal Bureau of Investigation (FBI) , 



East Rutherford Police 



Department, East Rutherford, New Jersey, who provided the following 
information: ^t) 



stated that while assigned to a traffic detail, 

diver ting traf fic from Route 3 East to Route 12 North and Route 3 
West , | l observed a white qhevrole^. van traveling slower than 
other vehicle on Route 3 East. 



recalled a message 



transmitted by dispatch of a national broadcast to be on the 
lookout for a white Chevrolet van bearing NJ registr ation JYJ 13Y, 
related to the terro rist attack earlier in th e day. I I 
immediately informed I I of the possibility 

that he has observed the white CHEVROLET van wanted in connection 
of the terrorists attack. £ u) 



stopped the vehicle al ong with 



and 



the occupants from the vehicle. [_ 



1 who assisted in removing 
j advised that the following 



occupants were transported to the State Police facilities ins ide 
the Meadow land s Sports Complex by New Jersey Stat e Tro opers : f 



white ma le 
DO 



D OB: f 



i 



-1 



white male. CuT 



0b7| I wh 



1 whi te ma le; f 



DOB:L 



ite male; and 



_^^^_^ DOB 
I white male 



I 



] 



dUbT 



, , advised that prior to the S tate Troo pers 

; transporting the occupants to their facility, I ~1 was told by 

"We are Israeli. We are not your problem. Your 



problems are our problems 



] then told 



the incident 



told r 
. « Ct*T 



The Palestinians are the problem." 
"We were on the west side highway during 



93 



W 



advised that he will write a detailed Police 



i§ reported for his department documenting the incident . ^ u \ 

Wt AU^NFGRMATIONCONTSfi 
4 ' HEREIN ISURet^SiFtED EXCEPT 
WHERE SBGWtfOTRERWLSE 




Investigation on 9/ll/ 1 



at NEW JERSEY 



lb 7 A 



Ib6 
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Filed] 

by a 



^fijLfyj Date dictated 9/11/01 



bl 



SA 



This document contains neither recommendations nor conclusions of th< 
it and its contents are not to be distributed outside your agency. 



ft): 



jS 



* Chief of Police * 
John R. LaGreca 



.ST RUTHERFORD POLICE DEPARTMENT 
312 Grove Street 
East Rutherford, New Jersey 07073 



Telephone 
201-438-0165 



CSRR 
014157 



[X] PRELIMINARY POLICE REPORT 
[ ] SUPPLEMENTAL REPORT 
DATE TIME DAY LOCATION 

09/11/01 1556 Tue 



Rt-3 East 
Service Rd. 



Nature of Report 
Police Information 



COMPLAINANT 
Address 



LN P0- 



FN 



Mile 7.9 



DOB 



he 

hlC 



Ph. 



This officer was on special detail at the above location diverting 
traffic from further travel on Rt 3 east re-routing the traffic north on Rtl20 
and 3 west . 

While diverting traffic, this officer was informed by dispatch of a 
national broadcast related to the terrorist attack earlier in the day. The 
information relayed was to be on the look out for a 2 000 chevy van color white 
NJ registration JYJ13Y occupied with approximately 3 or more individuals 
(unclear as to male or female) . A short time later this officer observed a van 
traveling quite slower than the rest of traffic east towards me on the service 
road that appeared t o be a newer model chevy with at least two occupants . I 
immediately informed | ] (The OIC at the scene) of the possibility of a 

match on the vehicle. As this officer approached the vehicle I did not observe 
a front license plate. 

I went to the rear of the vehicle and observed the license plate (NJ 
JRJ13Y) I felt that the one letter difference in the plate could have been a 
mistake and requested a confirmation. The return transmission revealed the 
plate on the van matched the broadcast so at this time I returned to the 
driver door and requested the driver to stop the vehicle and exit . The Driver 
did not immediately exit the vehicle and was asked several more times but he 
appeared to be fumbling with a black leather fann y pouch type of bag. This 
officer then physically removed him. I I removed the passenger and one 

othe r passenger from the passenger si de of the van and with minor assistance 
from | | the other two occupants were removed 

placed on the grass off to the shoulder and this officer read all five 
individuals their miranda rights. The van was secured and headquarters was 
requested to immediately notify the County Bomb Squad and FBI of the 
situation. 

All occupants were transported to the state police facilities inside the 
Meadowlands sports complex bv State Troopers t o await the arriv al of the FBI. 

w/m dob I I addresses s 



The oc cupants were ( Driver) | 

given: | ( Brooklyn NY a nd f 



[Isr ael wear ing blue jeans torn 
I w/m dob I I 

] Miami Beach Fl 3 313 9 Wearing jean overalls., I I no 



knees and a gray and black shirt. [ 



address g iven/ wearing a pink shirt and blue jeans. |_ 



3: 



J w/m dob 



No address given and uncert ain of clothing description but indiv idual 



was holding a n American Express Card^ 



dob [ 



J of 



■i: 



r 



Manhatten NY 



| only personal 
belongings were a pack of Cigarettes and black sunglasses. I am not sure to 



w/m 



j the position of the other passengers. 



.J&L 



taesst^ 



W+*. 



Report of P0- 



batb. 



Officer in Charge 



* Chief of Police * 
John R. LaGreca 



EAST RUTHERFORD POLICE. DEPARTMENT 

312 Grove Street 
East Rutherford, New Jersey 07073 



Telephone 
201-438-0165 



CSRR 
014157 



DATE 
09/11/01 



[x] PRELIMINARY POLICE REPORT 
[ ] SUPPLEMENTAL REPORT 
TIME DAY LOCATION 

1556 



Tue 



Nature of Report 
Police Information 



Rt 3 East 
Service Rd #7.9 



he 
hie 



COMPLAINANT LN PO 
Address 



FN 



DOB 



Ph. 



Prior to the transportation to the State Police facilities this officer 
was told without question by the driver "We are Israeli, We are not your 
problem. Your prob lems are our proble ms, The Palestinians are the problem. 



I was also told by 



"We were on the west side highway during 



the incident." The black bag that the driver was fumbling with contained all 
of his belonging s (see attached Receipt from the FBI for its contents) . 

"T was in possession of a white sock like sack filled with $4,70( 
in cash ( see attached receipt from FBI) . 

This officer did not speak to the Special Agent in charge Kevin Donovan and 
there were many other agen ts i nvolved in the investigation. Two o f which were 

and 



Report of PO- 



Officer in Charge 



Chief of Police * 
John R. LaGreca 



EAST RUTHERFORD POLICE. DEPARTMENT 

312 Grove Street 
East Rutherford, New Jersey 07073 



Telephone 
201-438-0165 



CSRR 
014157 



DATE 
09/11/01 



[ ] PRELIMINARY POLICE REPORT 
[X] SUPPLEMENTAL REPORT 
TIME DAY L OCATION 

1556 



COMPLAINANT LN 
Address ERPD 



Tue 



Nature of Report 
Police- Information 

FN 



Rt-3 
South-Service-Rd 



Ph. 



b6 
b7C 



DOB 



32 



I 



While on a traffic detail diverting traffi c to Rt 

closed, we were informed by our desk officer PO 

broadcast looking for a 2000 white Chevy van, NJ rea. 
least 3 people. After a short period of time, PO | 

traffic detail with me, advised me that a van which was slowly approaching us 

PO [ 



120 as Rt. 3 east was 
that there was a 
13Y, occupied by at 
who was on the 



approached the driver ' s 
was able to see at 
Officer 



matches that description of the broadcast 

side of the vehicle and I approached the passenger siae. I 
least 4 people in the van, two in the front and two in the back. 

| read the plate num ber and I contacted the desk for confirmation on the 
plate number. PO | | advised me that the plate #, NJ reg. JRJ-13Y is one 
number off. He then contacted Hq and then it was confirmed that the plate on 
the vehi cle was i n fact the plate that the FBI had stated in the broadcast 



While P0| I was removing the driver from the vehicle, I removed the front 

seat passenger and one of the rear seat passengers. As I was removing the 
front seat passenger he s tated " we're Isre ali" . He was identified, via Isreal 



passport as 

were on their way to 

roommate . 



1 W/M Dob f 



]of 



Isreal. He advised me that they 

1 in Brooklyn where they are staying with a 

He did not have the exact address . I I and I I 

arrived at the scene. All five males were handcuffed and PO 



read them their miranda warnings. All five spoke and understood English and 
they acknowledged their understanding of miranda. * 

Bergen Cou nty Bomb Squad, State Police and FBI notified. 



the vehicle was 

NY. The rear passengers were: 



W/M Dob 



T 



of 



The driver of 
1 Brooklyn, 



of 



^ ^ t W/M Dob 

I | Miami Bea ch, FL (he was wearing blue jean overalls) ; | 

Dob I Kno address given - wearing a pink shirt and blue jeans) ; 



and 



W/M 



] 



W/M Dob[ 



i 



of [ 



J Manhatten, NY. 

All five were seperately 



FBI agents responded and tooK over the scene 
transported to the State Police facilities in the Meadowlands Sports Complex 
by State Troopers, Further investigation by the FBI. 






Report of 



Officer in Charge 



DC 

d7C 



.-"" 



J 




Federal Bureau of iNVEsnomoN 



ONE GATEWAY OT. 
MARKET STREET 
NEWARK, NJ 07102 









SPECIAL AGENT 





















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p-57^«, 




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1 $W^ cJU^To^fc" 



Mi Aw/ foJv." ^2 .33/31ooan 



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ALL XNSQEOCAXKftr C0NTAU3ED ! 



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<*475 7 



■A- A -A' A A- A A A A -A- A -A A A A- A A* A A A A A A A A A A 

LAPD-90230 09/1:1/01 1615 



STATEWIDE BROADCAST aaaaaaaaaaaaaaaaaaaaaaaaaa 



AM.NJNSFODOO 

13 i 10 09/11/2001 05286- 

13 i 10 09/11/2001 06032 NJ 

TXT CAP) 

REQUEST NATIONAL BROADCAST 

TO i A L L R E E I V E R S 



RE 



P I. - VEHICLE POSSIBLY RELATED TO NYC TERRORIST 
ATTACK * * CORRECTION ON REGISTRATION 



A WHITE 2000 CHEVROLET- VAN WITH NEW JERSEY REG/JRJ13Y WITH 
"URBAN MOVING SYSTEMS" SIGN ON BACK WAS -SEEN AT THE LIBER I Y 
STATE PARK, JERSEY CITY N.J. AT THE TIME OF THE FIRST IMPACT OF 
A -JFT ATRIINER INTO THE WORLD TRADE CENTER. THREE INDIVIDUALS 
WITH THE VAN WERE SEEN CELEBRATING AFTER THE INITIAL -IMPACV^AND 
SUBSEQUENT EXPLOSION. 

F.B.T, NEWARK FIELD OFFICE IS REQUESTING THAT IF THE VAN IS 
iOOATFD, HOLD FOR PRINTS AND DETAIN INDIVIDUALS. CONTACT S.A. 



" 4 1 T H ANY I NFO RM AT I ON , 
a NJSP OPERATIONAL DISPATCH NJNSPODOO JO 
aa MSB ROUTED TO CRTS FROM NJSP OPE 



bo 
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1606ET 



aa MSG ROUTED TO CRTS . FROM NJSP OPERATIONAL DISPATCH 



a 09/11/01 



16 1 



r 



ALL XHPOHMAOTOSr CGHTAIHED* 



Do 

■b7C 



S> NEW JERSEY 

' k,tifL 



Mofofl'sMe' 
Services 



LEASED VEHICLE REGISTRATION 

.. ~.._... hi i iiiiiMiu.xiUMlliUlllff'IIUuyiriiliulQnlAfF/'Ji.l III 




- MOTOR VEHICLE SERVICES 
I RECEIPT DOCUMENT ONLY 



*X r 5W T£^ „, HOV 2001 VIN: 1GCEG15W4Y1142815 



Kff DL:B1B&! S 

„ tv N y 11530 DUPLICATE PT:PA 
jToOOO FEB 5.00 AR BG20012390037 



'pO BOX 83 
GARDEN CITY 



M 11530 



ME: CHE 

YEAR:2000 

TYPE: VAN 

MODEL: 

COLOR:WT 

PT:PA 

AX:2 

GW: 5000 

EQ: 5000 

REGCD:15 



REGD : 
FD REG: 
POST AUDIT: 
PLATE FEE: 



5.00 



TOTAL: 
AR 



5.00 
BG20012390037 



'()tfl/$'' 



'*'"■'' v'*'i'''"''' 



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INSURANCE IDENTIFICATION CARD 



IV2A (1-96) 

(STATE) NJ 

COMPANY NUMBER COMPANY 

111 EMPIRE FIRE & MARINE INS CO 

POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE 

CABIND080601 

YEAR 



08/06/2001 



10/06/2001 



MAKE/MODEL 
GMC/VAN 



VEHICLE IDEMJ1FICATION NUMBER 
1GCEG15W4Y1142815 






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AGENCY/COMPANY ISSUING CARD 

DeBellls Insurance Agency, Inc. 
492 Franklin Avenue (973)661-1500 
Nutley, NJ 07110 



INSURED 



URBAN MOVING SYSTEMS INC 
3 18TH STREET 
WEEHAWKEN.NJ 07087 



SEE IMPORTANT NOTICE ON REVERSE SIDE 



t * 



'FD-597 (Rev 8-11-94) 



File #• 



Page 

UNITED STATES DEPARTMENT OF JUSTICE 
FEDERAL BUREAU OF INVESTIGATION 

Receipt for Property Received/Returned/Released/Seized 



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UNITED STATES DEPARTMENT OF JUSTICE 

FEDERAL BUREAU OF INVESTIGATION 

Receipt for Property Received/Returned/Released/Seized 



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item(s) listed below were: 
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FD-302 (Rev. 10-6-95) 

DATE: 07-30-2010 

CLASSIFIED BY UC60322LP/PLJ/CC 

REASON: 1.4 (C) 

DECLASSIFY 01: 07-30-2035 




* 



FEDERAL BUREAU OF INVESTIGATION 



ALL INFORMATION CONTAINED 

HEREIN IS UNCLASSIFIED EXCEPT 
WHERE SHOOT OTHERWISE 



Date of transcription 09/14/2001 



In connection with a canvass conducted by the below-. . 

referenced Special Agent at the apartment building located at | | 



Union City, NJ, to identify individuals reporting 

any unusual activity around the apartment building over the prior 
few days, the following interview was conducted: (u\ 



E 



date of birth 



~~] Union City, NJ, telephone [ 

was interviewed. Alter' being advised of the official 



identity of the interviewing agent and the purpose of the interview 
she provided the following information:^) 

The morning of the interview, a white van was parked in 
the rear parking lot of the apartment complex. The van was white 
and had no windows on the sides. It appeared to be a utility van 
for an electric company. The name of the company, since forgotten, 
was in red letters on the van. ^u) 

Usually, utility or service vehicles at the complex 
building parked in the front. This vehicle was parked in the back 
which is why it came to the interviewee's attention. It seemed out 
of place. No further information was available. Cu) 



b6 
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This report is being submitted in connection with Lead NK1148.£tO 



<s$<*>* 



ALL IN 

HEREIN IS U 
WHERE 




ED 
FiED EXCEPT 
ISE 



DATE 
CLASSIFIED B^" 

REASON:! 



?fcrbly+x=r 



IF¥ON:_^&£i&. 



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Investigation on 09/11/2001 at Union City, NJ 




Date dictated Q9/14/200.1 



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This document Contains neither recommendations nor Conclusions Of theT pT Tt in thfl imnniutir nf thn BBT n«H in Innnnri 1 In imm rnimmr 



it and its contents are not to Be distributed outside your agency. 



FD-302 (Rev. 10-6-95) 



• 




# 



tALL INFORMATION CONTAINED 
HERE II IS UNCLASSIFIED EXCEPT 
WHERE SHOOT OTHERWISE 



-1- 

DATE: 07-30-2010 

CLASSIFIED BY UC60322LP/PLJ/CC FEDERAL BUREAU OF INVESTIGATION 

REASON: 1.4 (C) 
DECLASSIFY ON: 07-30-2035 



Date of transcription 09/14/2001 

Pursuant to a Federal Grand Jury subpoena issued in the 
District of New Jersey, I I 



TmJ 



These records were placed in a 1-A envelope. (u} 



\ 



b3 



CL^mfegr^ jg, a aM^» 1 cM^=r 




REASON: 1.4( <L ) 
DECLASS 



ALUNFORMfMNCQNS^D 
HEREIN IS UN2&^glED EXCEPT 
WHERESHOWNOTHEF 



investigation on 09/14/01 at Newark, NJ 



b7A File t 



by SA 



jQtjj) '..^r^gjffit^ ^ ed ' ctated 09/14/01 



b6 
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-&■ 




This document contains neither recommendations nor conclusions of the FE 
it and its contents are not to be distributed outside your agency. 



bl 




FEDERAL- BUREAU OF INVESTIGATION 

FOIPA 
DELETED PAGE INFORMATION SHEET 

No Duplication Fees are charged for Deleted Page Information Sheet(s). 



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